Compositions and methods for genetically-encoded high voltage-activated calcium channel blockers using engineered ubiquitin ligases

ABSTRACT

The present disclosure provides, inter alia, nanobodies targeting a CaVβ auxiliary subunit and compositions thereof. Methods for blocking a High-Voltage Activated Calcium Channel (HVACC) using such compositions, methods for selectively targeting a population of cells in a subject, and methods for treating or ameliorating the effects of a disease in a subject are also provided.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of PCT international application no. PCT/US2020/025359, filed on Mar. 27, 2020, which claims benefit of U.S. Provisional Patent Application Ser. No. 62/886,733, filed on Aug. 14, 2019, U.S. Provisional Patent Application Ser. No. 62/883,637, filed on Aug. 6, 2019, U.S. Provisional Patent Application Ser. No. 62/854,688, filed on May 30, 2019, U.S. Provisional Patent Application Ser. No. 62/830,142, filed on Apr. 5, 2019, and U.S. Provisional Patent Application Ser. No. 62/825,784, filed on Mar. 28, 2019, which applications are incorporated by reference herein in their entireties.

GOVERNMENT FUNDING

This invention was made with government support under grant nos. GM107585, DK118866, and HL142111 awarded by the National Institutes of Health (NIH). The government has certain rights in the invention.

FIELD OF DISCLOSURE

The present disclosure provides, inter alia, genetically-encoded High-Voltage Activated Calcium Channel (HVACC) inhibitors including nanobodies targeting a Ca_(V)β auxiliary subunit and compositions thereof. Also provided are treatment methods using the same.

INCORPORATION BY REFERENCE OF SEQUENCE LISTING

This application contains references to amino acids and/or nucleic acid sequences that have been filed concurrently herewith as sequence listing text file “CU19283-pro4-seq.txt”, file size of 43 KB, created on Aug. 6, 2019. The aforementioned sequence listing is hereby incorporated by reference in its entirety pursuant to 37 C.F.R. § 1.52(e)(5).

BACKGROUND OF THE DISCLOSURE

High-Voltage Activated Calcium Channels (HVACCs) are critical for the function of excitable cells such as neurons. They permit the release of neurotransmitters, hormones, and initiate the contraction of both skeletal and cardiac muscle. As such, calcium channel blockers have been prominent drug targets for diseases as diverse as hypertension, cardiac arrhythmias, diabetes, Parkinson's disease, and chronic pain. The latter is estimated to affect 20% of the global population, with large economic and social consequences. Despite this large prevalence, current treatments for chronic pain remain inadequate, as exemplified with a common treatment for chronic pain that has led to an epidemic of opioids.

Among HVACCs, the N-type calcium channel is a primary target for the treatment of chronic pain. It is well established that these channels are expressed in the sensory neurons that transmit the sensation of pain, that blockade of these channels can disrupt pain perception, and that these channels are upregulated in multiple models of pain. An N-type calcium channel blocker derived from marine snail venom (Prialt) is currently used in limited situations for pain management, but is limited by a narrow therapeutic window. The therapeutic potential to decrease/inhibit HVACCs in particular tissues extends beyond pain: calcium channel blockers are currently in clinical trials for the treatment of diabetes as well as Parkinson's disease. All current drugs block the channel at its functional location, the plasma membrane, by disrupting its ability to permit calcium entry into the cell. Given their central importance in many cells, a primary concern with all current pharmacological HVACC blockers is off-target effects.

Most drugs against HVACCs target the pore-forming α₁ subunit of the channel, disrupting the ability of the channel to permit calcium entry into the cell. HVACCs are also composed of auxiliary β and α₂-δ subunits which function to facilitate trafficking of the α₁ subunit to the plasma membrane and fine-tune its properties once there. As critical regulators of channel function, these auxiliary subunits are potential therapeutic targets. Indeed, Gabapentin (Pregabalin or Lyrica), is used for treatment of chronic pain and works by downregulating N-type calcium channels via an association with the α₂-δ subunit of the channel (the exact mechanism of how this occurs is under intense study). Gabapentin-based treatment produces fewer side effects compared to other treatment options such as opioids or tricyclic antidepressants, but full alleviation of pain is rare. Thus, there is a significant need for improved treatment options for this common condition. The auxiliary β subunit is obligatory for proper channel trafficking. Yet, despite efforts to target the α₁-β binding interface, this subunit remains an untapped therapeutic target.

Currently, there is no genetically-encoded molecule or means to specifically block all HVACCs. Naturally occurring genetically-encoded inhibitors like RGK proteins bind other proteins and affect other cellular processes, such as regulating the cytoskeleton. This means that a cocktail of HVACC blockers, some of them expensive venom-derived peptides, must be co-administered.

Accordingly, there is a need for genetically-encoded HVACC inhibitors, as well as for compositions and methods for the treatment of various diseases associated with HVACCs. This disclosure is directed to meeting these and other needs.

SUMMARY OF THE DISCLOSURE

Inhibiting high-voltage-activated calcium channels (HVACCs, Ca_(V)1/Ca_(V)2) is therapeutic for myriad cardiovascular and neurological diseases. For particular applications, genetically-encoded HVACC blockers may enable channel inhibition with greater tissue-specificity and versatility than is achievable with small molecules. In the present disclosure, a genetically-encoded HVACC inhibitor was engineered by first isolating an immunized llama nanobody (nb.F3) that binds auxiliary HVACC Ca_(V)β subunits. Nb.F3 by itself is functionally inert, providing a convenient vehicle to target active moieties to Ca_(V)β-associated channels. Nb.F3 fused to the catalytic HECT domain of Nedd4L (Ca_(V)-aβlator), an E3 ubiquitin ligase, ablated currents from diverse HVACCs reconstituted in HEK293 cells, and from endogenous Ca_(V)1/Ca_(V)2 channels in mammalian cardiomyocytes, dorsal root ganglion neurons, and pancreatic β cells. In cardiomyocytes, Ca_(V)-aβlator redistributed Ca_(V)1.2 channels from dyads to Rab-7-positive late endosomes. The present disclosure introduces Ca_(V)-aβlator as a potent genetically-encoded HVACC inhibitor, and describes a general approach that can be broadly adapted to generate versatile modulators for macro-molecular membrane protein complexes.

Accordingly, one embodiment of the present disclosure is a nanobody capable of binding to a Ca_(V)β auxiliary subunit, comprising SEQ ID NOs: 1-3, SEQ ID NOs: 5-7, SEQ ID NOs: 9-11, SEQ ID NOs: 13-15, SEQ ID NOs: 17-19, SEQ ID NOs: 21-23, SEQ ID NOs: 25-27, SEQ ID NOs: 29-31, SEQ ID NOs: 33-35, SEQ ID NOs: 37-39, SEQ ID NOs: 41-43, SEQ ID NOs: 45-47, SEQ ID NOs: 49-51, SEQ ID NOs: 53-54, SEQ ID NOs: 56-57, SEQ ID NOs: 59-61, SEQ ID NOs: 63-65, SEQ ID NOs: 67-69, SEQ ID NOs: 71-73, SEQ ID NOs: 75-77, SEQ ID NOs: 79-81, SEQ ID NOs: 83-85, SEQ ID NOs: 87-89, SEQ ID NOs: 91-93, or SEQ ID NOs: 95-97.

Another embodiment of the present disclosure is a composition comprising: (i) a nanobody as disclosed herein; and (ii) a catalytic domain of an E3 ubiquitin ligase operably connected to the nanobody.

Another embodiment of the present disclosure is a composition comprising a genetically encoded calcium channel blocker comprising a nucleic acid encoding: (i) a nanobody as disclosed herein; and (ii) a catalytic domain of an E3 ubiquitin ligase.

A further embodiment of the present disclosure is a method of blocking a High-Voltage Activated Calcium Channel (HVACC) in a cell, comprising contacting the cell with an effective amount of a composition as disclosed herein.

Another embodiment of the present disclosure is a method of selectively targeting a population of cells in a subject, comprising administering to the subject an effective amount of a composition as disclosed herein.

Another embodiment of the present disclosure is a composition for inducible inhibition of a High-Voltage Activated Calcium Channel (HVACC) in a cell comprising: (i) a nanobody as disclosed herein; and (ii) a C1 domain from protein kinase Cγ(C1_(PKC)) operably connected to the nanobody; wherein the composition is effective to inactivate the HVACC after induction with phorbol-12,13-dibutyrate (PdBu).

An additional embodiment of the present disclosure is a composition comprising a genetically encoded inducible calcium channel blocker comprising a nucleic acid encoding: (i) a nanobody as disclosed herein; and (ii) a C1 domain from protein kinase Cγ(C1_(PKC)) operably connected to the nanobody.

Another embodiment of the present disclosure is a method of blocking a High-Voltage Activated Calcium Channel (HVACC) in a cell, comprising the step of: (i) contacting the cell with an effective amount of a composition as disclosed herein; and (ii) contacting the cell with phorbol-12,13-dibutyrate (PdBu); wherein the contacting of steps (i) and (ii) are effective to remove the HVACC from its functional location on a plasma membrane of the cell.

Still another embodiment of the present disclosure is a method for treating or ameliorating the effects of a disease in a subject, comprising administering to the subject an effective amount of a composition as disclosed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

The application file contains at least one drawing executed in color. Copies of this patent application with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.

FIGS. 1A-1G show the development of a pan-Ca_(V)β nanobody. FIG. 1A shows the size-exclusion chromatograph and Coomassie gel (inset) showing purified Ca_(v)β₁ from baculovirus-infected HEK293 GnTl⁻ cells. FIG. 1B provides a representative flow-chart of nanobody generation according to the present disclosure. FIG. 1C shows a phage ELISA using Ca_(V)β₁ as bait and periplasmic extracts from single infected E. coli clones. Red bars represent clones that were selected for subsequent analyses; blue bar represents a negative control from an E. coli expressing an anti-GFP nanobody. FIG. 1D is a cartoon showing conventional IgG antibody (left) and camelid heavy-chain antibody (center). On the right is a schematic representation of the variable heavy chain (VHH or nanobody) of camelid heavy-chain antibodies. The three CDR loops which are the primary determinants of antigen-binding are shown in red, green, and blue. FIG. 1E shows the sequence alignment of CDR3 from selected clones. In FIG. 1F, on the left is a schematic of a co-translocation assay to determine nanobody/Ca_(V)β interaction in HEK293 cells. On the right are the confocal images showing membrane co-translocation of Ca_(V)β_(X)-YFP and nb.F3-CFP-C1_(PKCγ) in response to treatment with 1 μM of the phorbol ester, phorbol 12,13-dibutyrate (PdBu). In FIG. 1G, on the left shows an exemplar isothermal titration calorimetry trace using purified Ca_(V)β_(2b) and nb.F3. On the Right shows a summary of ITC thermodynamic parameters. N, stoichiometry; K_(d), dissociation constant; K_(a), affinity constant; ΔH, enthalpic change; ΔS entropic change. T=298K.

FIGS. 2A-2L show that nb.F3 is functionally silent on reconstituted Ca_(V)2.2 channels. FIG. 2A is a schematic of an experimental strategy according to the present disclosure in which BBS-α_(1B)-YFP was transfected in HEK293 cells with α₂δ, Ca_(V)β and either CFP or nb.F3-P2A-CFP. FIG. 2B shows a representative flow cytometry dot plot of cells expressing BBS-α_(1B)-YFP+Ca_(V)β₁+α₂δ-1 and either CFP (left) or nb.F3-P2A-CFP (right). Approximately 100,000 cells are represented here and throughout. Horizontal and vertical lines represent the threshold for YFP- and Alexa-647-positive cells, respectively, as determined with single color controls. FIG. 2C shows the cumulative distribution histogram of Alexa-647 (left) or YFP fluorescence (right) from CFP (black) or nb.F3 (red) expressing cells. YFP-positive cells were selected for the analysis; dashed lines represent thresholds for Alexa-647 and YFP fluorescence signals above background. FIG. 2D shows a summary of flow cytometry data of surface (647, filled) and total (YFP, patterned) levels of BBS-α_(1B)-YFP. Data from nb.F3-expressing cells was normalized to CFP control group. n=>5,000 cells analyzed per experiment, N=4 separate experiments, error bars, s.e.m. FIG. 2E shows a representative experimental strategy according to the present disclosure in which HEK293 cells were transfected with BBS-α_(1B)+Ca_(V)β-YFP+α₂δ-1. FIGS. 2F-2H are in the same format as FIGS. 2B-2D for cells expressing BBS-α_(1B)+Ca_(V)β-YFP+α₂δ-1±nb.F3-P2A-CFP. FIG. 2I shows representative whole-cell Ba²⁺ currents (top) and population I-V curves (bottom) in HEK293 cells expressing α_(1B)+Ca_(V)β₁+α₂δ-1 and either CFP (black) or nb.F3-P2A-CFP (red). FIGS. 2J-2L are in the same format as FIG. 2I for cells expressing Ca_(V)β₂ (FIG. 2J), Ca_(V)β₃ (FIG. 2K), and Ca_(V)β₄ (FIG. 2L). Scale bar 1 nA, 10 ms. Data are means±s.e.m., n=10 for each point.

FIGS. 3A-3J show the functional impact of a chimeric nb.F3-Nedd4L protein (Ca_(V)-aβlator) on reconstituted Ca_(V)2.2 channels. FIG. 3A is a schematic of a representative experimental design according to the present disclosure in which HEK293 cells were transfected with BBS-α_(1B)+Ca_(V)β-YFP+α₂δ-1, and either nb.F3, nb.F3-Nedd4L, or nb.F3-Nedd4L[C942S]. FIG. 3B shows representative histograms (left) and summary data (right) of flow cytometry experiments measuring total (YFP) levels of Ca_(V)β_(1b)-YFP. Each data set was normalized to a control group that expressed CFP. n>5,000 cells analyzed per experiment, N=3 separate experiments, error bars, s.e.m. FIG. 3C shows representative histograms (left) and summary data (right) of flow cytometry experiments measuring surface (647) levels of BBS-α_(1B). The white dashed line is the threshold for 647 signal above background. FIG. 3D shows an experimental strategy according to the present disclosure, which has the same format as in FIG. 3A except YFP was fused to BBS-α_(1B), enabling measurement of the total levels of the α_(1B) subunit. FIGS. 3E-3F are in the same format as FIGS. 3B-3D for cells expressing BBS-α_(1B)-YFP+Ca_(V)β+α₂δ-1. FIG. 3G shows representative traces (top) and population I-V curves (bottom) from whole-cell patch clamp measurements in HEK293 cells expressing α_(1B)+Ca_(V)β_(1b)+α₂δ-1 and nb.F3 (black, I_(peak, 0mV)=−103.5±39.5 pA/pF, n=10), nb.F3-Nedd4L (red, I_(peak, 0mV)=−3±0.53 pA/pF, n=11), or nb.F3-Nedd4L[C942S] (green, I_(peak, 0mV)=−117±34.8 pA/pF, n=8). FIGS. 3H-3J are in the same format as FIG. 3G for Ca_(V)2.2 channels reconstituted with Ca_(V)β₂ (FIG. 3H), Ca_(V)β₃ (FIG. 3I), and Ca_(V)β₄ (FIG. 3J) with nb.F3 (black) or nb.F3-Nedd4L (red). Scale bar 1 nA, 10 ms. Data are means±s.e.m., n=10 for each point. *P<0.05 compared with control, one-way ANOVA with Tukey's multiple comparison test. †P<0.01 compared with control, unpaired, two-tailed Student's t-test.

FIGS. 4A-4D show that Ca_(V)-aβlator inhibits distinct reconstituted HVACCs. FIG. 4A shows population I-V curves from HEK293 expressing α_(1C)+β_(1b)+α₂δ-1 with either nb.F3 (black, I_(peak, 0mV)=−48.4±8.4 pA/pF, n=12) or Ca_(V)-aβlator (red, I_(peak, 0mV)=−0.93±0.16 pA/pF, n=8). FIGS. 4B-4D are in the same format as FIG. 4A for cells expressing reconstituted Ca_(V)1.3 (FIG. 4B), Ca_(V)2.1 (FIG. 4C), or Ca_(V)2.3 (FIG. 4D) channels. Data are means±s.e.m. †p<0.01 compared with control, unpaired, two-tailed Student's t-test.

FIGS. 5A-5H show the Ca_(V)-aβlation of endogenous Ca_(V)1.2 in cardiomyocytes. FIG. 5A shows confocal images (top) and representative traces from whole-cell recordings of uninfected guinea pig cardiomyocytes (left), or infected with adenovirus expressing either Ca_(V)-βlator (middle) or nb.F3-Nedd4L[C942S] (right). Scale bar 0.2 nA, 10 ms. FIG. 5B shows population I-V curves from cardiomyocytes expressing Ca_(V)-βlator (red), nb.F3-Nedd4L[C942S] (green), or an uninfected control (black). In FIG. 5C, on the left, shows representative confocal images of cardiomyocytes fixed and immunostained with α_(1C) (green) and ryanodine receptor (RyR2, magenta) antibodies. The yellow boxes indicate regions of high-zoom merge image. On the right, a graph shows co-localization between α_(1C) and RyR in uninfected cardiomyocytes (gray, PCC=0.47±0.02, n=15), and those expressing either Ca_(V)-aβlator (red, PCC=0.24±0.02 n=19), or nb.F3-Nedd4L[C942S] (green, PCC=0.50±0.01, n=17). In FIG. 5D, on the left, shows representative confocal images of fixed cardiomyocytes immunostained with α_(1C) (green) and Rab7 (magenta) antibodies. The yellow boxes indicate regions of high-zoom merge image. On the right, a graph shows colocalization between α_(1C) and Rab7 in uninfected cardiomyocytes (gray, PCC=0.29±0.02, n=16), and those expressing either Ca_(V)-aβlator (red, PCC=0.42±0.02, n=18), or nb.F3-Nedd4L[C942S] (green, PCC=0.30±0.03, n=16). FIG. 5E shows the pulldown of α_(1C) in HEK293 cells expressing α_(1C), β_(1b) and either CFP, nb.F3, Ca_(V)-aβlator, or nb.F3-Nedd4L-[C942S]. Top panel, shows probing pulldown with α_(1C) antibody. Bottom panel, shows the same blot stripped and re-probed with ubiquitin antibody. FIG. 5F shows the quantification of four separate experiments, as performed in FIG. 5E. Data are means±s.e.m for each point. *p<0.05 compared to control, one-way ANOVA with Tukey's multiple comparison test. FIG. 5G shows the pulldown of Ca_(V)β₁b, as in FIG. 5E. Left panel, shows probing with Ca_(V)β₁b. Right panel, shows the same blot stripped and re-probed with ubiquitin antibody. FIG. 5H is a cartoon illustrating Ca_(V)-aβlator-induced relocation of Ca_(V)1.2 from dyads to Rab7-positive late endosomes in cardiomyocytes.

FIGS. 6A-6G show the Ca_(V)-aβlation of HVACCs in DRG neurons and pancreatic β-cells. FIG. 6A shows representative Fura-2 traces of murine DRG neurons infected with GFP (left panel), F3-Nedd4L (middle panel), F3-Nedd4L[C942S] (right panel), with confocal images in inset. The orange bars represent depolarization with 40 mM KCl. FIG. 6B shows a summary of the maximum responses from neurons infected with GFP (Peak response=1.25±0.04, n=84), F3-Nedd4L (1.04±0.01, n=77), and F3-Nedd4L[C942S] (1.30±0.05, n=92) in response to 40 mM KCl. Peaks were normalized to the baseline, defined as 1 min prior to the addition of KCl. FIG. 6C shows representative traces of DRG neurons infected with GFP (left), F3-Nedd4L (middle), F3-Nedd4L[C942S] (right). Traces were collected at both a holding potential of −90 mV (top) and −50 mV (bottom). Notably, Ca_(V)-aβlator-infected neurons still show robust T-type current when held at −90 mV. FIG. 6D shows population I-V curves from DRG neurons infected as in FIG. 6A. Measurements were made at a holding potential of −90 mV. Symbols are mean currents calculated from 15 to 20 ms of a 20 ms test pulse. Data are means±s.e.m. FIG. 6E shows representative fura-2 traces from dispersed pancreatic islets infected with Ca_(V)-aβlator (left) or F3-Nedd4L[C942S] (right) challenged with 16.8 mM glucose (blue bars) and 40 mM KCl (orange bars). FIG. 6F shows a summary of the maximum responses from pancreatic β-cells infected with GFP (Peak response=1.22±0.02, n=53), F3-Nedd4L (Peak response=1.04±0.01, n=62), and F3-Nedd4L[C942S] (Peak response=1.18±0.01, n=122) in response to 16.8 mM glucose. FIG. 6G shows a summary of the maximum responses from pancreatic β-cells infected with GFP (Peak response=1.25±0.02, n=77), F3-Nedd4L (Peak response=1.04±0.01, n=62), and F3-Nedd4L[C942S] (Peak response=1.21±0.01, n=122) in response to 40 mM KCl. Data are means±s.e.m. *p<0.05 compared to control, one-way ANOVA with Tukey's multiple comparison test.

FIG. 7 shows that nb.F3 binds all four Ca_(V)β subunits in the cytosol of mammalian cells. Left, is a schematic of the phorbol ester 12,13-dibutyrate (PdBu) translocation assay. Right, shows confocal images of HEK293 cells expressing nb.F3-CFP-C1_(PKCγ) and a YFP-Ca_(V)β before (top) and after (bottom) the addition of 1 μM Pdbu.

FIGS. 8A-8F show representative flow cytometry data for BBS-α_(1B) with YFP-Ca_(V)β₂-Ca_(V)β₄. FIG. 8A shows representative flow cytometry dot plot of cells transfected with BBS-α_(1B), α₂-δ, YFP-Ca_(V)β₂ and CFP (left) or nb.F3 (right). FIG. 8B shows a cumulative distribution histogram of data from FIG. 8A of Alexa-647 (left) or YFP fluorescence (right) from CFP (black) or nb.F3 (red) expressing cells. YFP-positive cells (n=>5,000 cells/experiment) were selected for analysis; the threshold for 647 labeling and YFP fluorescence above background is represented with the dashed line. FIGS. 8C and 8D are in the same format as in FIGS. 8A and 8B for cells expressing YFP-Ca_(V)β₃. FIGS. 8E and 8F are in the same format as in FIGS. 8A and 8B for cells expressing Ca_(V)β₄.

FIGS. 9A-9E show that nb.F3 is functionally silent on reconstituted Ca_(V)1.2 channels. FIG. 9A shows a cartoon of an experimental strategy according to the present disclosure. BBS-α_(1C) was transfected in HEK293 cells with each YFP-Ca_(V)β and either CFP or nb.F3-P2A-CFP. FIG. 9B shows a representative flow cytometry dot plot of cells transfected with BBS-α_(1C), Ca_(V)β₁ and CFP (left) or nb.F3 (right). FIG. 9C shows a cumulative distribution histogram of Alexa-647 (left) or YFP fluorescence (right) from CFP (black) or nb.F3 (red) expressing cells. YFP-positive cells (n>5,000 cells/experiment) were selected for analysis; the threshold for 647 labeling and YFP fluorescence above background is represented with the dashed line. FIG. 9D shows a summary of flow cytometry data of surface (647, filled) and total (YFP, patterned) levels of BBS-α_(1C). Data from nb.F3 was normalized to CFP control group. N=4 separate experiments, error bars, s.e.m. FIG. 9E shows population I-V curves from whole-cell patch clamp measurements in HEK293 cells expressing α_(1C), Ca_(V)β_(2a), and CFP (black, n=9) or nb.F3 (red, n=12). Data are means±s.e.m.

FIGS. 10A-10H show representative flow cytometry data for Ca_(V)-aβlation of BBS-α_(1B) with YFP-Ca_(V)β₂-Ca_(V)β₄. FIG. 10A shows a representative flow cytometry dot plot of cells transfected with BBS-α_(1B), α₂-δ, YFP-Ca_(V)β₁ and nb.F3 (left), nb.F3-Nedd4L (middle) or nb.F3-Nedd4L[C942S] (right). FIG. 10B shows a histogram of YFP (left) or Alexa-647 fluorescence (right) from samples in FIG. 10A. YFP-positive cells (n>5,000/experiment) were selected for analysis, the threshold for 647 labeling above background is represented with the dashed line. FIGS. 10C and 10D are in the same format as FIGS. 10A and 10B for cells expressing YFP-Ca_(V)β₂. FIGS. 10E and 10F are in the same format as FIGS. 10A and 10B for cells expressing YFP-Ca_(V)β₃. FIGS. 10G and 10H are in the same format as FIGS. 10A and 10B for cells expressing YFP-Ca_(V)β₄.

FIGS. 11A-11D show the functional impact of a chimeric nb.F3-Nedd4L protein (Ca_(V)-aβlator) on reconstituted Ca_(V)1.2 channels. FIG. 11A shows a schematic of an experimental design according to the present disclosure. HEK293 cells were transfected with BBS-α_(1C), YFP-Ca_(V)β, and either nb.F3, nb.F3-Nedd4L or nb.F3-Nedd4L[0942S]. FIG. 11B shows a representative flow cytometry dot plot of cells transfected with BBS-α_(1C), YFP-Ca_(V)β_(1b) and nb.F3 (left), nb.F3-Nedd4L (middle) or nb.F3-Nedd4L[0942S] (right). FIGS. 11C and 11D show histograms of YFP (FIG. 11C) and Alexa-647 (FIG. 11D) fluorescence from samples in FIG. 11B (left) and summary data from N=3 separate experiments (right). YFP-positive cells (n>5,000 cells per experiment) were selected for analysis, the threshold for 647 labeling above background is represented with the dashed line. *p<0.05 compared with control, one-way ANOVA with Tukey's multiple comparison test.

FIGS. 12A-12D show that Ca_(V)-aβlator does not redistribute α_(1C) to Rab5 early-endosomes or lysosomes, nor decrease total levels of α_(1C) or β₂. FIG. 12A shows a comparison of total α_(1C) levels in uninfected cardiomyocytes (gray, n=15) and those infected with nb.F3-Nedd4L (red, n=19). FIG. 12B shows a comparison of total β₂ levels in uninfected cardiomyocytes (gray, n=15) and those infected with nb.F3-Nedd4L (red, n=16), normalized to uninfected controls. Data are means±s.e.m. FIG. 12C (left panel) shows representative confocal images of uninfected (top) or F3-Nedd4L-infected (bottom) guinea pig cardiomyocytes, fixed and immunostained with antibodies towards α_(1C) (left) and LAMP1 (middle). The right panel shows colocalization between α_(1C) and Rab5 in uninfected cardiomyocytes (gray, n=7) and those expressing F3-Nedd4L (red, n=7). Data are means±s.e.m. FIG. 12D is in the same format as FIG. 12C, showing immunostaining and colocalization analysis of cardiomyocytes immunostained against α_(1C) and Rab5.

DETAILED DESCRIPTION OF THE DISCLOSURE

Inhibition of high-voltage-activated calcium channels (HVACCs) is an important prevailing or potential therapy for diverse cardiovascular (hypertension, cardiac arrhythmias, cerebral vasospasm) and neurological diseases (epilepsy, chronic pain, Parkinson's disease) (Zamponi et al., 2015). Small molecule HVACC inhibitors include Ca_(V)1 blockers (dihydropyridines, benzothiazepenes phenylalkylamines) and venom peptides that target Ca_(V)2.1 (ω-agatoxin), Ca_(V)2.2 (ω-conotoxin), and Ca_(V)2.3 (SNX-482) channels. When introduced into an organism, small-molecule HVACC blockers are typically widely distributed leading to off-target effects that can narrow the therapeutic window and, thereby, adversely impact therapy. Genetically-encoded HVACC inhibitors can circumvent off-target effects because they can be selectively expressed in target tissues or cells; thus, they may be useful alternatives or complements to small molecule therapy (Yang et al., 2013; Murata et al., 2004).

There are seven distinct HVACCs (Ca_(V)1.1-Ca_(V)1.4, Ca_(V)2.1-Ca_(V)2.3) which exist in cells as multi-subunit complexes comprising pore-forming al-subunits assembled with auxiliary proteins which include β, α₂-δ, and γ subunits (Zamponi et al., 2015; Buraei and Yang, 2010; Dolphin, 2012). HVACCs are named according to the identity of the component α₁ subunit (α_(1A)-α_(1F); α_(1S)) which also contains the voltage sensor, selectivity filter, and channel pore. The various auxiliary subunits typically regulate HVACC trafficking, gating, and modulation, and are recognized as potential targets for developing HVACC-directed therapeutics. For example, gabapentin, which is clinically utilized for treating epilepsy and neuropathic pain, targets HVACC α₂-δ subunits (Gee et al., 1996). Based on the presumption that the association of α₁ with β is obligatory for the formation of surface-targeted functional HVACCs as indicated by heterologous expression experiments (Buraei and Yang, 2010), disruption of the α₁-β interaction has been long pursued as a strategy to develop HVACC inhibitors (Young et al., 1998; Findeisen et al., 2017; Chen, 2018; Khanna et al., 2019). To this end, over-expression of peptides derived from the al-interaction domain (AID) which contains the amino acid sequence responsible for high-affinity α₁-β association (Pragnell et al., 1994; Van Petegem et al., 2004; Chen et al., 2004; Opatowsky et al., 2003), has been utilized by several groups as putative genetically-encoded HVACC inhibitors (Findeisen et al., 2017; Yang et al., 2019). However, the efficacy of this approach in vivo may be limited as recent data suggests that in some adult tissue the α₁-β interaction is not absolutely essential for surface trafficking of HVACCs (Yang et al., 2019; Meissner et al., 2011).

Rad/Rem/Rem2/Gem/Kir (RGK) proteins are endogenous small Ras-like G-proteins that profoundly inhibit all HVACCs when over-expressed in either heterologous cells or native tissue (Beguin et al., 2001; Finlin et al., 2003; Chen et al., 2005; Xu et al., 2010). They form ternary complexes with HVACCs via binding to constituent β subunits and inhibit currents via multiple mechanisms including removal of surface channels and impairing gating (Yang and Colecraft, 2013; Yang et al., 2010). Despite their efficacy, utility of RGKs as genetically-encoded HVACC inhibitors is confounded by potential off-target effects since they interact with and regulate other binding partners such as cytoskeletal proteins, 14-3-3, calmodulin, and CaM kinase II (Yang and Colecraft, 2013; Correll et al., 2008; Royer et al., 2018; Béguin et al., 2005; Ward et al., 2004). A critical unmet need is the development of genetically-encoded HVACC inhibitors that possess the high efficacy of RGKs but lack the problematic interactions with other signaling proteins. The present disclosure achieves this goal by fusing the homologous to the E6-AP carboxyl terminus (HECT) catalytic domain of the E3 ubiquitin ligase, neural precursor cell developmentally down-regulated protein 4 (Nedd4-2 or hereafter referred to as Nedd4L), to a Ca_(V)β-targeted nanobody. The resulting construct, termed Ca_(V)-aβlator, eliminated diverse HVACCs both in both reconstituted systems and native excitable cells, providing a unique new tool for probing Ca_(V)1/Ca_(V)2 signaling and regulation in vivo, and potential development into a therapeutic.

Ubiquitin (Ub) is a small, 9 kilodalton protein that is covalently attached to a target protein as a post-translational modification. The transfer of cytosolic Ub onto a protein is a multi-step reaction that culminates with a class of enzymes called E3 ubiquitin ligases mediating the final step of Ub attachment. There are more than 600 E3 ubiquitin ligases in the human genome; this diversity could in part be explained by the diverse nature of the ubiquitin code: Ub chains are formed by the subsequent addition of Ub onto an existing Ub bound to the target protein. Complexity arises as Ub itself has 7 lysine residues that can be potentially ubiquitinated (as well as its N-terminal methionine). The shape of the resulting polyubiquitin chains can alter the downstream fate of the target protein. For example, K48 E3 ligases have been demonstrated in vitro to add Ub onto the 48th residue of an existing Ub, forming K48 polyubiquitin chains which have been characterized as a signal for proteosomal degradation of the target protein. Additional signaling roles for ubiquitin have been characterized such as K63 branches coordinating endocytosis of plasma membrane proteins. In particular, the HECT family ligase Nedd4-2 has been well characterized to target to the plasma membrane, where it mediates endocytosis and ultimately lysosomal degradation of a host of PY-containing transmembrane proteins such as ENaC, KCNQ1, and NaV1.5.

The present disclosure provides, inter alia, a strategy to genetically encode HVACC inhibitors, providing a means to spatially restrict therapy to a certain tissue or cell population, by utilizing the ubiquitin pathway. According to some embodiments, certain aspects of the present disclosure target the β subunit and take advantage of the ubiquitin pathway to remove HVACCs from the cell surface.

In some embodiments, the present disclosure comprises two elements: 1) a novel nanobody that is able to bind all four Ca_(V)13 auxiliary subunits, and linked to 2) a catalytic domain of an E3 ubiquitin ligase. In some embodiments, rather than physically blocking the channel from performing its function, the channel is removed from its functional destination, the plasma membrane. In some embodiments, the channel is removed from its functional destination in a genetically-encoded manner, allowing cellular specificity to be achieved with, but not limited to, transfection or viral-vector based methods. In some embodiments, the ubiquitin signaling system present in all eukaryotic cells is utilized in order to redirect ubiquitination, and thus functional knockdown of HVACCs.

In order to direct the ubiquitin machinery to HVACCs, in some embodiments, the present disclosure provides a generated nanobody towards the auxiliary β subunit (Ca_(V)β) of HVACCs. As used herein, the term “nanobodies” means small antibody fragments derived from a class of camelid antibodies having a small size ( 1/10th the size of a conventional antibody). According to some embodiments, the nanobodies are amenable to genetic engineering and further, they are able to bind their antigen with a single heavy variable chain, endowing them with unique stability within the reducing environment of a living cell. According to some embodiments, the present disclosure provides an engineered catalytic domain of the HECT domain E3 ubiqutin ligase Nedd4-2 onto a Ca_(V)β nanobody to create a genetically-encoded calcium channel blocker. In some embodiments, by engineering the catalytic domain of a ubiquitin ligase, including but not limited to Nedd4-2, onto the nanobody, the ubiquitination of the β auxiliary subunit is targeted, which is necessary for proper HVACC trafficking to the plasma membrane. In some embodiments, this targeting is sufficient to abolish surface levels of some, including a minority, a majority and even all HVACCs. In some embodiments, the present disclosure provides a genetically-encoded calcium channel blocker. In some embodiments, the calcium channel blocker of the present disclosure blocks HVACCs in a spatially defined manner.

According to some embodiments, this disclosure provides a novel means to block all HVACCs by a fundamentally different mechanism than that of typical HVACC blockers. In some embodiments, the HVACC blockers of the present disclosure may be used for treatment of diabetes and Parkinson's disease, and as a gene therapy approach for a number of diseases. In some embodiments, the disclosure is genetically encoded to be delivered with spatial precision, minimizing off-target effects.

According to some embodiments, the present disclosure provides a nanobody that recognizes some or all Ca_(V)β subunits enabling the targeting of endogenous HVACCs. In some embodiments, the catalytic subunit of the E3 ubiquitin ligase Nedd4-2 is used with a nanobody.

According to some embodiments, the present disclosure provides, 1) a means to block all HVACCs, without the need for several pharmacological agents, including expensive venom-derived peptides, to achieve similar functional effects; 2) a genetically-encoded means to achieve HVACC blockade, which may target a particular tissue and may be delivered via adenovirus/AAV or transfection methods, providing a means to target specific tissues; 3) a gene therapy by selectively targeting populations of neurons that mediate pain sensation; and 4) a nanobody homing device that can be used to target other active protein moieties to HVACCs.

According to some embodiments, the present disclosure provides a genetically-encoded HVACC blocker (in contrast to several expensive pharmacological agents). In some embodiments, the present disclosure provides a gene therapy to selectively down-regulate function of HVACCs in specific populations of cells.

In particular, twenty-five unique Ca_(V)β-targeted nanobodies were developed and identified based on the unique sequences within complementarity determining regions (CDR1-3), the major determinants of antigen binding. These nanobodies may be incorporated into Ca_(V) channel complexes but be functionally silent, and thereby serve as a vehicle to potentially address distinct enzymatic moieties or sensors to endogenous channels.

Accordingly, one embodiment of the present disclosure is a nanobody capable of binding to a Ca_(V)β auxiliary subunit, comprising SEQ ID NOs: 1-3, SEQ ID NOs: 5-7, SEQ ID NOs: 9-11, SEQ ID NOs: 13-15, SEQ ID NOs: 17-19, SEQ ID NOs: 21-23, SEQ ID NOs: 25-27, SEQ ID NOs: 29-31, SEQ ID NOs: 33-35, SEQ ID NOs: 37-39, SEQ ID NOs: 41-43, SEQ ID NOs: 45-47, SEQ ID NOs: 49-51, SEQ ID NOs: 53-54, SEQ ID NOs: 56-57, SEQ ID NOs: 59-61, SEQ ID NOs: 63-65, SEQ ID NOs: 67-69, SEQ ID NOs: 71-73, SEQ ID NOs: 75-77, SEQ ID NOs: 79-81, SEQ ID NOs: 83-85, SEQ ID NOs: 87-89, SEQ ID NOs: 91-93, or SEQ ID NOs: 95-97.

In some embodiments, the nanobody comprises SEQ ID NO: 4, SEQ ID NO: 8, SEQ ID NO: 12, SEQ ID NO: 16, SEQ ID NO: 22, SEQ ID NO: 26, SEQ ID NO: 30, SEQ ID NO: 34, SEQ ID NO: 38, SEQ ID NO: 42, SEQ ID NO: 46, SEQ ID NO: 48, SEQ ID NO: 52, SEQ ID NO: 55, SEQ ID NO: 58, SEQ ID NO: 62, SEQ ID NO: 66, SEQ ID NO: 70, SEQ ID NO: 74, SEQ ID NO: 78, SEQ ID NO: 82, SEQ ID NO: 86, SEQ ID NO: 90, SEQ ID NO: 94, or SEQ ID NO: 98.

Another embodiment of the present disclosure is a composition comprising: (i) a nanobody as disclosed herein; and (ii) a catalytic domain of an E3 ubiquitin ligase operably connected to the nanobody. In this context, the term “operably connected” means that one function is regulated by another thing by association with a polypeptide sequence on, e.g., a single polypeptide.

In some embodiments, the composition is effective to remove a High-Voltage Activated Calcium Channel (HVACC) from its functional location on a plasma membrane of a cell. In some embodiments, the HVACC is selected from the group consisting of Ca_(V)1.1, Ca_(V)1.2, Ca_(V)1.3, Ca_(V)1.4, Ca_(V)2.1, Ca_(V)2.2, Ca_(V)2.3, and combinations thereof. In some embodiments, the HVACC is one or more of Ca_(V)1.2, Ca_(V)1.3, Ca_(V)2.1, and Ca_(V)2.3. In some embodiments, the composition is effective to achieve functional knockdown of the HVACC. In some embodiments, the E3 ubiquitin ligase comprises the catalytic domain of Nedd4-2. In some embodiments, the composition is effective to impair the function of a Ca_(V)β auxiliary subunit of trafficking the HVACC to the plasma membrane. In some embodiments, the composition is effective to abolish surface levels of some, including a minority of, a majority of and even all HVACCs. In some embodiments, the composition is effective to reduce or eliminate HVACC currents.

Another embodiment of the present disclosure is a composition comprising a genetically encoded calcium channel blocker comprising a nucleic acid encoding: (i) a nanobody as disclosed herein; and (ii) a catalytic domain of an E3 ubiquitin ligase.

In some embodiments, the E3 ubiquitin ligase comprises a catalytic domain of Nedd4-2. In some embodiments, the nanobody and the catalytic domain of the E3 ubiquitin ligase are operably connected, i.e., functionally linked. In this context, the term “operably connected” means that one function is regulated by another thing by association with a polynucleotide sequence on, e.g., a single polynucleotide. In some embodiments, the nanobody and the catalytic domain of the E3 ubiquitin ligase are expressed to form a contiguous polypeptide. In some embodiments, the contiguous polypeptide is effective to remove a High-Voltage Activated Calcium Channel (HVACC) from its functional location on a plasma membrane of a cell. In some embodiments, the HVACC is selected from the group consisting of Ca_(V)1.1, Ca_(V)1.2, Ca_(V)1.3, Ca_(V)1.4, Ca_(V)2.1, Ca_(V)2.2, Ca_(V)2.3, and combinations thereof. In some embodiments, the HVACC is one or more of Ca_(V)1.2, Ca_(V)1.3, Ca_(V)2.1, and Ca_(V)2.3. In some embodiments, the contiguous polypeptide is effective to achieve functional knockdown of a HVACC in the cell. In some embodiments, the contiguous polypeptide is effective to impair, e.g., to decrease or abolish the function of a Ca_(V)β auxiliary subunit of trafficking a HVACC to the plasma membrane. In some embodiments, the contiguous polypeptide is effective to abolish surface levels of all HVACCs. In some embodiments, the contiguous polypeptide is effective to reduce or eliminate HVACC currents. In some embodiments, the nucleic acid encoding (i) and (ii) is carried on an expression vector. In some embodiments, the expression vector further comprises a tissue specific promoter.

A further embodiment of the present disclosure is a method of blocking a High-Voltage Activated Calcium Channel (HVACC) in a cell, comprising contacting the cell with an effective amount of a composition as disclosed herein.

In some embodiments, the cell is a neuron or a cardiac myocyte.

Another embodiment of the present disclosure is a method of selectively targeting a population of cells in a subject, comprising administering to the subject an effective amount of a composition as disclosed herein.

In some embodiments, the cells are neurons that mediate pain sensation or cardiac myocytes.

In some embodiments, the subject is a mammal. In some embodiments, the subject is a human.

Another embodiment of the present disclosure is a composition for inducible inhibition of a High-Voltage Activated Calcium Channel (HVACC) in a cell comprising: (i) a nanobody as disclosed herein; and (ii) a C1 domain from protein kinase Cγ(C1_(PKC)) operably connected to the nanobody; wherein the composition is effective to inactivate the HVACC after induction with phorbol-12,13-dibutyrate (PdBu). In the present disclosure, the C1 domain of protein kinase Cy may be induced using known inducing agents, such as, e.g., phorbol esters, including PdBu. Although, PdBu is exemplified herein, other protein kinase Cy inducing agents may be used, including but not limited to, e.g., Bryostatin 1, ingenol-3-angelate (I3A, PEP005), phorbol-12-myristate-13-acetate (PMA), prostratin, SC-9, SC-10, 1-oleoyl-2-acetyl-sn-glycerol, (−)-indolactam V, ingenol, 1-stearoyl-2-arachidonoyl-sn-glycerol.

In some embodiments, the composition is effective to achieve functional knockdown of the HVACC. In this context, the term “functional knockdown” means using an agent such as the composition according to the present disclosure to cause transient loss of normal function of a HVACC, including, e.g., exciting neurons, releasing neurotransmitters, hormones, or initiating the contraction of both skeletal and cardiac muscle, etc. The “functional knockdown” of a HVACC can be quantified by conventional techniques such as, e.g., RT-qPCR.

An additional embodiment of the present disclosure is a composition comprising a genetically encoded inducible calcium channel blocker comprising a nucleic acid encoding: (i) a nanobody as disclosed herein; and (ii) a C1 domain from protein kinase Cγ(C1_(PKC)) operably connected to the nanobody.

In some embodiments, the nanobody and the C1 domain are expressed to form a contiguous polypeptide. In some embodiments, the nucleic acid encoding (i) and (ii) is carried on an expression vector. In some embodiments, the expression vector further comprises a tissue specific promoter. In the present disclosure, non-limiting exemplary tissue specific promoters include, e.g., native promoters such as B29 promoter, CD14 promoter, CD43 promoter, CD45 promoter, CD68 promoter, desmin promoter, elastase-1 promoter, endoglin promoter, fibronectin promoter, flt-1 promoter, GFAP promoter, GPIIb promoter, ICAM-2 promoter, mouse INF-β promoter, Mb promoter, NpshI promoter, OG-2 promoter, SP-B promoter, SYN-1 promoter, WASP promoter, and composite promoters such as SV40/bAlb promoter, SV40/hAlb promoter, SV40/CD43 promoter, SV40/CD45 promoter, NSE/RU5′ promoter.

Another embodiment of the present disclosure is a method of blocking a High-Voltage Activated Calcium Channel (HVACC) in a cell, comprising the step of: (i) contacting the cell with an effective amount of a composition as disclosed herein; and (ii) contacting the cell with a protein kinase Cy inducing agent, such as phorbol-12,13-dibutyrate (PdBu); wherein the contacting of steps (i) and (ii) are effective to remove the HVACC from its functional location on a plasma membrane of the cell. As used herein, the term “blocking” means partially or completely interfering with the HVACC so as to achieve a desired clinical effect.

In some embodiments, the cell is f a neuron or a cardiac myocyte.

Still another embodiment of the present disclosure is a method for treating or ameliorating the effects of a disease in a subject, comprising administering to the subject an effective amount of a composition as disclosed herein.

In some embodiments, the subject is a mammal. In some embodiments, the subject is a human.

In some embodiments, the disease is associated with dysregulation of a high-voltage-activated calcium channel (HVACC). In some embodiments, the HVACC is selected from the group consisting of Ca_(V)1.1, Ca_(V)1.2, Ca_(V)1.3, Ca_(V)1.4, Ca_(V)2.1, Ca_(V)2.2, Ca_(V)2.3, and combinations thereof. In some embodiments, the HVACC is one or more of Ca_(V)1.2, Ca_(V)1.3, Ca_(V)2.1, and Ca_(V)2.3.

In some embodiments, the disease is selected from the group consisting of a cardiovascular disease, a neurological disease, and combinations thereof. Non-limiting examples of a cardiovascular disease include angina, myocardial infarction, stroke, heart failure, hypertension, cardiac arrhythmias, cerebral vasospasm, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular heart disease, carditis, endocarditis, myocarditis, eosinophilic myocarditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, venous thrombosis, and combinations thereof. In some embodiments, the cardiovascular disease is selected from the group consisting of hypertension, cardiac arrhythmias, cerebral vasospasm, and combinations thereof.

Non-limiting examples of a neurological disease include epilepsy, chronic pain, Parkinson's disease, amyotrophic lateral sclerosis (ALS), Alzheimer's disease, aneurysm, back pain, Bell's palsy, birth defects of the brain and spinal cord, brain injury, brain tumor, cerebral palsy, chronic fatigue syndrome, consussion, dementia, Disk disease of neck and lower back, dizziness, Guillain-Barré syndrome, headaches and migraines, multiple sclerosis, muscular dystrophy, neuralgia, neuropathy, neuromuscular and related diseases, severe depression, obsessive-compulsive disorder, scoliosis, seizures, spinal cord injury, spinal deformity and disorders, spine tumor, stroke, vertigo, and combinations thereof. In some embodiments, the neurological disease is selected from the group consisting of epilepsy, chronic pain, Parkinson's disease, and combinations thereof.

As used herein, the terms “treat,” “treating,” “treatment” and grammatical variations thereof mean subjecting an individual subject to a protocol, regimen, process or remedy, in which it is desired to obtain a physiologic response or outcome in that subject, e.g., a patient. In particular, the methods and compositions of the present disclosure may be used to slow the development of disease symptoms or delay the onset of the disease or condition, or halt the progression of disease development. However, because every treated subject may not respond to a particular treatment protocol, regimen, process or remedy, treating does not require that the desired physiologic response or outcome be achieved in each and every subject or subject population, e.g., patient population. Accordingly, a given subject or subject population, e.g., patient population, may fail to respond or respond inadequately to treatment.

As used herein, the terms “ameliorate”, “ameliorating” and grammatical variations thereof mean to decrease the severity of the symptoms of a disease in a subject.

As used herein, a “subject” is a mammal, preferably, a human. In addition to humans, categories of mammals within the scope of the present disclosure include, for example, agricultural animals, veterinary animals, laboratory animals, etc. Some examples of agricultural animals include cows, pigs, horses, goats, etc. Some examples of veterinary animals include dogs, cats, etc. Some examples of laboratory animals include primates, rats, mice, rabbits, guinea pigs, etc.

As used herein, the term “contacting” means bringing a composition and optionally one or more additional therapeutic agents into close proximity to the cells in need of modulation such as blocking or inhibiting HVACC activities. This may be accomplished using conventional techniques of drug delivery to the subject or in the in vitro situation by, e.g., providing the compound and optionally other therapeutic agents to a culture media in which the cells are located.

In the present disclosure, an “effective amount” or “therapeutically effective amount” of a composition is an amount of such a composition that is sufficient to effect beneficial or desired results as described herein when administered to a subject or contacted with a cell. Effective dosage forms, modes of administration, and dosage amounts may be determined empirically, and making such determinations is within the skill of the art. It is understood by those skilled in the art that the dosage amount will vary with the route of administration, the rate of excretion, the duration of the treatment, the identity of any other drugs being administered, the age, size, and species of the subject, and like factors well known in the arts of, e.g., medicine and veterinary medicine. In general, a suitable dose of a composition according to the disclosure will be that amount of the composition, which is the lowest dose effective to produce the desired effect with no or minimal side effects. The effective dose of a composition according to the present disclosure may be administered as two, three, four, five, six or more sub-doses, administered separately at appropriate intervals throughout the day.

A suitable, non-limiting example of a dosage of a composition according to the present disclosure is from about 1 ng/kg to about 1000 mg/kg, such as from about 1 mg/kg to about 100 mg/kg, including from about 5 mg/kg to about 50 mg/kg. Other representative dosages of a composition of the present disclosure include about 1 mg/kg, 5 mg/kg, 10 mg/kg, 15 mg/kg, 20 mg/kg, 25 mg/kg, 30 mg/kg, 35 mg/kg, 40 mg/kg, 45 mg/kg, 50 mg/kg, 60 mg/kg, 70 mg/kg, 80 mg/kg, 90 mg/kg, 100 mg/kg, 125 mg/kg, 150 mg/kg, 175 mg/kg, 200 mg/kg, 250 mg/kg, 300 mg/kg, 400 mg/kg, 500 mg/kg, 600 mg/kg, 700 mg/kg, 800 mg/kg, 900 mg/kg, or 1000 mg/kg.

A composition of the present disclosure may be administered in any desired and effective manner: for oral ingestion, or as an ointment or drop for local administration to the eyes, or for parenteral or other administration in any appropriate manner such as intraperitoneal, subcutaneous, topical, intradermal, inhalation, intrapulmonary, rectal, vaginal, sublingual, intramuscular, intravenous, intraarterial, intrathecal, or intralymphatic. Further, a composition of the present disclosure may be administered in conjunction with other treatments. A composition of the present disclosure may be encapsulated or otherwise protected against gastric or other secretions, if desired.

The following examples are provided to further illustrate the methods of the present disclosure. These examples are illustrative only and are not intended to limit the scope of the disclosure in any way.

EXAMPLES Example 1 Materials and Methods Protein Purification

The BacMam expression system was used to purify Ca_(V)β_(1B) and Ca_(V)β₃ (Goehring et al., 2014). Briefly, full-length Ca_(V)β_(1b) and Ca_(V)β₃ were cloned into a modified pEG BacMam vector with a C-terminal FLAG tag using BamHI and EcoRI sites. BacMam virus was subsequently generated in Sf9 cells and harvested after three rounds of amplification. 100 mL of BacMam virus was used to infect 1 L of HEK293 GnTl⁻ cells (N-acetylglucosaminyltransferase I-negative) and kept shaking at 37° C. After 18 hrs the cells were stimulated with 10 mM sodium butyrate and harvested 72 hrs later. Cells were lysed using an Avestin Emulsiflex-C3 homogenizer in buffer containing 50 mM Tris, 150 mM KCl, 10% sucrose, 1 mM PMSF (phenylmethylsulfonyl fluoride), and EDTA-free Complete protease inhibitor cocktail (Roche), pH 7.4. Lysate was spun down at 35,000 g for 1 hr. Ca_(V)β was subsequently isolated from supernatant with anti-FLAG antibody (M2) affinity chromatography, and eluted with 100 μg/mL FLAG peptide (Sigma Millipore) in 50 mM TrisHCl, 150 mM KCl, pH 7.4. The protein was then applied to an ion exchange column (MonoQ, GE) and eluted with a linear KCl gradient of 50 mM to 1M. Peak fractions were collected and subjected to size exclusion chromatography (Superdex 200, GE) in a buffer containing 20 mM Tris, 150 mM KCl, pH 7.4. Proteins were brought to 20% glycerol, flash frozen, and stored at −80° C.

For isothermal titration calorimetry experiments, both Ca_(V)δ_(2b) and nb.F3 were cloned via Gibson assembly (Gibson et al., 2009) into an IPTG (isopropyl δ-D-1-thiogalactopyranoside) inducible, kanamycin-resistant pET derived plasmid (Novagen, Madison, Wis.), with an N-terminal deca-histidine tag (His10) and transformed into Rosetta DE3 E. coli (Millipore Sigma), following manufacturers' instructions. Cells were grown at 37° C. in 1 L 2×TY media supplemented with 50 μg/mL carbenicillin and 35 μg/mL chloramphenicol and shook at 225 rpm. Protein expression was induced with 0.2 mM IPTG when the cells reached an OD of 0.6-0.8. The cells were then grown overnight at 22° C.

Nb.F3 was purified as previously described (McMahon et al., 2018): briefly, cells were harvested and resuspended in 100 mL buffer containing (mM) 500 sucrose, 200 Tris (pH 8), 0.5 EDTA and osmotically shocked with the addition of 200 mL water with stirring. The lysate was brought to a concentration of (mM) 150 NaCl, 2 MgCl₂, and 20 imidazole and centrifuged at 20,000 g, 4° C. for 30 min. The supernatant was combined with 2 mL Ni-NTA Sepharose resin (Qiagen) in batch, washed with 70 mM imidazole, and eluted with 350 mM imidazole. The eluant was dialyzed into a buffer containing 150 mM NaCl, 10 mM HEPES, pH 7.4 and purified with an S200 size exclusion column (GE Healthcare).

For the purification of Ca_(V)β_(2b), cells were pelleted and resuspended in a buffer containing (mM) 300 NaCl, 20 Tris HCl, 10% glycerol, pH 7.4, 0.5 PMSF, and EDTA-free Complete protease inhibitor cocktail (Roche). Cells were lysed using an Avestin Emulisflex-C3 homogenizer and spun at 35,000 g for 30′. The solubilized protein was applied to Ni-NTA Sepharose (Qiagen) and purified as nb.F3.

Nanobody Generation

One llama was immunized with an initial injection of 600 μg purified Ca_(V)β_(1b) and Ca_(V)β₃, with four boosters of 200 ug each protein administered every other week (Capralogics Inc, Hardwick, Mass.). 87 days after the first immunization, lymphocytes were isolated from blood and a cDNA library with ProtoScript II Reverse Transcriptase (New England Biolabs). Nanobodies were isolated as previously described (Pardon et al., 2014), using a two-step nested PCR. Amplified Vhh genes were cloned into the phagemid plasmid pComb3xSS. A phage display library was created using electrocompetent TG1 E. coli cells (Lucigen). Three rounds of phage display were performed as previously described (Pardon et al., 2014), using 100 nM biotinylated Ca_(V)β₃ as bait on neutravidin-coated Nunc-Immuno plates (Thermo Scientific). Clones of interest were subsequently cloned into mammalian expression systems for further study (see below).

Isothermal Titration Calorimetry

Isothermal Titraction calorimetry measurements were performed using an MicroCal Auto iTC 200 (Malvern Panalytical) at 25° C. Samples were dialyzed into 300 mM NaCl, 20 mM HEPES, 5% glycerol, pH 7.5 and filtered beforehand. Injections of 2 μL nb.F3 into 400 μL of Ca_(V)62b. Data were processed with MicroCal Origin 7.0.

Molecular Biology and Plasmid Construction

Potential nbs were PCR amplified with primers flanking their conserved framework (FW) FW1 and FW4 regions and inserted into the mammalian expression plasmid pcDNA3 (Invitrogen) using HindIII and EcoRI sites. An additional GSG linker was included in the PCR and the insert was ligated upstream of an enhanced CFP and C1 domain of human PKCγ (residues 51-180).

Rat Ca_(V)β_(1b) was PCR amplified for subsequent overlap PCR with YFP, inserting a GSG linker between the two proteins. The resulting Ca_(V)β_(1b)-GSG-YFP sequence was digested with BamHI and NotI and ligated into a PiggyBac CMV mammalian expression vector (System Biosciences). A similar cloning strategy was used for Ca_(V)β₃ and Ca_(V)β₄. Rat Ca_(V)β_(2a) was PCR amplified with an N-terminal YFP to prevent palmitoylation of the β_(2a) subunit (Chien et al., 1996) and inserted with a similar strategy.

A customized bicistronic vector (xx-P2A-CFP) was synthesized in the pUC57 vector, in which coding sequence for P2A peptide was sandwiched between an upstream multiple cloning site and enhanced cyan fluorescent protein (CFP) (Genewiz). The xx-P2A-CFP fragment was amplified by PCR and cloned into the PiggyBac CMV mammalian expression vector (System Biosciences) using NheI/NotI sites. To generate nb.F3-P2A-CFP, we PCR amplified the coding sequence for nb.F3 and cloned it into xx-P2A-CFP using NheI/AflII sites. A similar backbone was created in the PiggyBac CMV mammalian expression vector in which CFP-P2A-xx contained a multiple cloning site downstream of the P2A site (Genewiz). Nb.F3 was PCR amplified and ligated into the vector with BglII/AscI sites. The HECT domain of human Nedd4L (Gao et al., 2009) consisting of residues 594-974 was PCR amplified and inserted downstream of nb.F3 using AscI/AgeI sites. Mutagenesis of C942S was accomplished using site-directed mutagenesis.

α_(1B)-BBS, harboring two tandem 13 residue bungarotoxin-binding sites (SWRYYESSLEPYPD) in the domain IV S5-S6 extracellular loop, was obtained. α_(1C) and α_(1C)-BBS, and α_(1C)-BBS-YFP have been described previously (Yang et al., 2010; Kanner et al., 2017).

Cell Culture and Transfection

Human embryonic kidney (HEK293) cells were obtained Cells were Mycoplasma free, as determined by the MycoFluor Mycoplasma Detection Kit (Invitrogen, Carlsbad, Calif.). Low passage HEK293 cells were cultured at 37° C. in DMEM supplemented with 5% fetal bovine serum (FBS) and 100 mg/mL of penicillin-streptomycin. HEK293 cell transfection was accomplished using the calcium phosphate precipitation method. Briefly, plasmid DNA was mixed with 7.75 μL of 2 M CaCl₂ and sterile deionized water (to a final volume of 62 μL). The mixture was added dropwise, with constant tapping to 62 μL of 2× Hepes buffered saline containing (in mM): Hepes 50, NaCl 280, Na₂HPO₄ 1.5, pH 7.09. The resulting DNA-calcium phosphate mixture was incubated for 20 min at room temperature and then added dropwise to HEK293 cells (60-80% confluent). Cells were washed with Ca²⁺-free phosphate buffered saline after 4-6 hr and maintained in supplemented DMEM.

Isolation of adult guinea pig cardiomyocytes was performed in accordance with the guidelines of Columbia University Animal Care and Use Committee. Prior to isolation, plating dishes were precoated with 15 μg/mL laminin (Gibco). Adult female Hartley guinea pigs (Charles River) were euthanized with 5% isoflurane, hearts were excised and ventricular myocytes isolated by first perfusing in KH solution (mM): 118 NaCl, 4.8 KCl, 1 CaCl₂) 25 HEPES, 1.25 K₂HPO₄, 1.25 MgSO₄, 11 glucose, 02 EGTA, pH 7.4, followed by KH solution without calcium using a Langendorff perfusion apparatus. Enzymatic digestion with 0.3 mg/mL Collagenase Type 4 (Worthington) with 0.08 mg/mL protease and. 05% BSA was performed in KH buffer without calcium for six minutes. After digestion, 40 mL of a high K⁺ solution was perfused through the heart (mM): 120 potassium glutamate, 25 KCl, 10 HEPES, 1 MgCl₂, and 02 EGTA, pH 7.4. Cells were subsequently dispersed in high K⁺ solution. Healthy rod-shaped myocytes were cultured in Medium 199 (Life Technologies) supplemented with (mM): 10 HEPES (Gibco), lx MEM non-essential amino acids (Gibco), 2 L-glutamine (Gibco), 20 D-glucose (Sigma Aldrich), 1% vol vol⁻¹ penicillin-streptomycin-glutamine (Fisher Scientific), 02 mg/mL Vitamin B-12 (Sigma Aldrich) and 5% (vol/vol) FBS (Life Technologies) to promote attachment to dishes. After 5 hr, the culture medium was switched to Medium 199 with 1% (vol/vol) serum, but otherwise supplemented as described above. Cultures were maintained in humidified incubators at 37° C. and 5% CO₂.

Murine dorsal root ganglion (DRG) neurons were obtained. DRG neurons were isolated as previously described (Albuquerque et al., 2009). DRG neurons were plated onto glass coverslips coated with 15 μg/mL laminin (Corning) and maintained in Neurobasal media (Thermo Fisher Scientific) supplemented with 1×B-27 (Thermo Fisher Scientific), 100 μg mL⁻¹ penicillin/streptomycin (Fisher Scientific), 0.29 mg/mL L-glutamine (Gibco), 50 ng mL⁻¹ NGF (Sigma Aldrich), 2 ng mL⁻¹ GDNF (Sigma Aldrich), and 10 μM cytosine β-D-arabinofuranoside (Sigma Aldrich).

Pancreatic Beta Cell Isolation and Culture

Murine pancreatic β-cells from Rip-Cre (Jackson Laboratories Stock #003573) mice crossed with Rosa26-tdTomato (Jackson Laboratories Stock #007909) mice were obtained. Islets were isolated as previously described (Stull et al., 2012), dispersed with 0.05% trypsin EDTA (Gibco) and plated onto 35 mm glass bottom dishes with 10 mm microwells (Cellvis) pre-coated with 10 mg/mL fibronectin (Sigma Aldrich). Islets were maintained in RPMI 1640 media (Corning) supplemented with 15% FBS and 100 μg mL⁻¹ penicillin/streptomycin. Islets were imaged 24-48 hr after adenoviral infection.

Adenoviral Generation

Adenoviral vectors expressing GFP and CFP-P2A-nb.F3-Nedd4L[C942S] were generated using the pAdEasy system (Stratagene) according to manufacturer's instructions as previously described (Kanner et al., 2017; Subramanyam, 2013). Plasmid shuttle vectors (pShuttle CMV) containing cDNA for CFP-P2A-nb.F3-Nedd4L[C942S] were linearized with PmeI and electroporated into BJ5183-AD-1 electrocompetent cells pre-transformed with the pAdEasy-1 viral plasmid (Stratagene). PacI restriction digestion was used to identify transformants with successful recombination. Positive recombinants were amplified using XL-10-Gold bacteria, and the recombinant adenoviral plasmid DNA linearized with PacI digestion. HEK cells cultured in 60 mm diameter dishes at 70-80% confluency were transfected with PacI-digested linearized adenoviral DNA. Transfected plates were monitored for cytopathic effects (CPEs) and adenoviral plaques. Cells were harvested and subjected to three consecutive freeze-thaw cycles, followed by centrifugation (2,500×g) to remove cellular debris. The supernatant (2 mL) was used to infect a 10 cm dish of 90% confluent HEK293 cells. Following observation of CPEs after 2-3 d, cell supernatants were used to re-infect a new plate of HEK293 cells. Viral expansion and purification was carried out as previously described (Colecraft et al., 2002). Briefly, confluent HEK293 cells grown on 15 cm culture dishes (×8) were infected with viral supernatant (1 mL) obtained as described above. After 48 hr, cells from all of the plates were harvested, pelleted by centrifugation, and resuspended in 8 mL of buffer containing (in mM) 20 Tris HCl, 1 CaCl₂), one and MgCl₂ (pH 8). Cells were lysed by four consecutive freeze-thaw cycles and cellular debris pelleted by centrifugation. The virus-laden supernatant was purified on a cesium chloride (CsCl) discontinuous gradient by layering three densities of CsCl (1.25, 1.33, and 1.45 g/mL). After centrifugation (50,000 rpm; SW41Ti Rotor, Beckman-Coulter Optima L-100K ultracentrifuge; 1 hr, 4° C.), a band of virus at the interface between the 1.33 and 1.45 g/mL layers was removed and dialyzed against PBS (12 hr, 4° C.). Adenoviral vector aliquots were frozen in 10% glycerol at −80° C. until use. Generation of CFP-P2A-nb.F3-Nedd4L was performed by Vector Biolabs (Malvern, Pa.).

Flow Cytometry Assay of Total and Surface Calcium Channels

Cell surface and total ion channel pools were assayed by flow cytometry in live, transfected HEK293 cells as previously described (Kanner et al., 2017; Aromolaran et al., 2014). Briefly, 48 hr post-transfection, cells cultured in 12-well plates were gently washed with ice cold PBS containing Ca²⁺ and Mg²⁺ (in mM: 0.9 CaCl₂), 0.49 MgCl2, pH 7.4), and then incubated for 30 min in blocking medium (DMEM with 3% BSA) at 4° C. HEK293 cells were then incubated with 1 μM Alexa Fluor 647 conjugated α-bungarotoxin (BTX647; Life Technologies) in DMEM/3% BSA on a rocker at 4° C. for 1 hr, followed by washing three times with PBS (containing Ca²⁺ and Mg²⁺). Cells were gently harvested in Ca²⁺-free PBS, and assayed by flow cytometry using a BD Fortessa Cell Analyzer (BD Biosciences, San Jose, Calif., USA). CFP- and YFP-tagged proteins were excited at 407 and 488 nm, respectively, and Alexa Fluor 647 was excited at 633 nm.

Electrophysiology

Whole-cell recordings of HEK293 cells were conducted 48 hr after transfection using an EPC-10 patch clamp amplifier (HEKA Electronics) controlled by Pulse software (HEKA). Micropipettes were prepared from 1.5 mm thin-walled glass (World Precision Instruments) using a P97 microelectrode puller (Sutter Instruments). Internal solution contained (m M): 135 cesium-methansulfonate (CsMeSO₃), 5 CsCl, 5 EGTA, 1 MgCl₂, 2 MgATP, and 10 HEPES (pH 7.3). Series resistance was typically between 1-2 MΩ. There was no electronic resistance compensation. External solution contained (m M): 140 tetraethylammonium-MeSO₃, 5 BaCl₂, and 10 HEPES (pH 7.4). Whole-cell I-V curves were generated from a family of step depolarizations (−60 mV to +80 mV from a holding potential of −90 mV). Currents were sampled at 20 kHz and filtered at 5 kHz. Traces were acquired at a repetition interval of 10 s. Leak and capacitive transients were subtracted using a P/4 protocol.

Whole-cell recordings of cardiomyocytes and DRG neurons were performed 48 hr after infection. HEK cell internal and external solutions were used for DRG experiments. Whole-cell recordings for guinea pig cardiomyocytes used internal solution comprised of (mM): 150 CsMeSO₃, 10 EGTA, 5 CsCl, MgCl₂, 4 MgATP, and 10 HEPES. For formation of gigaohm seals and initial break-in to the whole-cell configuration, cells were perfused in Tyrode solution containing (mM): 138 NaCl, 4 KCl, 2 CaCl₂), 1 MgCl₂, 0.33 NaH₂PO₄, and 10 HEPES (pH 7.4). Upon successful break-in, the perfusing media was switched to an external solution composed of (mM): 155 N-methyl-D-glucamine, 10 4-amino-pyridine, 1 MgCl₂, 5 BaCl₂, and 10 HEPES (pH 7.4). Currents were sampled at 20 kHz and filtered at 5 kHz. Leak and capacitive transients were subtracted using a P/4 protocol.

Immunofluorescence Staining

Approximately 48 hr after adenoviral infection, guinea pig cardiomyocytes were fixed in 4% paraformaldehyde (wt/vol, in PBS) for 20 min at RT. Cells were washed twice with PBS and then incubated in 0.1M glycine (in PBS) for 10 min at RT to block free aldehyde groups. Fixed cells were then permeabilized with 0.2% Triton X-100 (in PBS) for 20 min at RT. Non-specific binding was blocked with a 1 hr incubation at RT in PBS solution containing 3% (vol vol⁻¹) normal goat serum (NGS), 1% BSA, and 0.1% Triton X-100. Cells were then incubated with primary antibody in PBS containing 1% NGS, 1% BSA, and 0.1% BSA overnight at 4° C. Cells were washed three times for 10 min each with PBS with 0.1% Triton X-100 and then stained with secondary antibody for 1 hr at RT. Antibody dilutions were prepared in PBS solution containing 1% NGS, 1% BSA, and 0.1% Triton X-100. The cells were then washed in PBS with 0.1% Triton X-100 and imaged in the same solution. Primary antibodies and working dilutions were as follows: α_(1C): Alomone, 1:1000; UC Davis/NIH NeuroMab Facility, clone N263/31, 1:200. RyR: Sigma Aldrich, 1:1000. Ca_(V)62: Alomone, 1:200. Rab7: Cell Signaling Technology, 1:100. Rab5: Cell Signaling Technology, 1:200. Lamp1: Developmental Studies Hybridoma Bank, created by the NICHD of the NIH and maintained at The University of Iowa, Department of Biology, Iowa City, Iowa 52242, 1:100. Secondary antibodies (Thermofisher) were used at a dilution of 1:1000.

Confocal Microscopy

Cells were plated onto 35 mm MatTek imaging dishes (MatTek Corporation). Images were captured on a Nikon A1RMP confocal microscope with a 40× oil immersion objective (1.3 N.A.). CFP, Alexa-488, YFP, and Alexa-647 were imaged using 458, 488, 514 and 639 nm laser lines, respectively.

Pulldown Assays

Transfected HEK293 cells cultured in 60 mm dishes were harvested in PBS, centrifuged at 2,000 g (4° C.) for 5 min, and the pellet resuspended in RIPA lysis buffer containing (mM): 150 NaCl, 20 Tris HCl, 1 EDTA, 0.1% (wt vol⁻¹) SDS, 1% Triton X-100, 1% sodium deoxycholate, and supplemented with protease inhibitor mixture (10 μL mL⁻¹, Sigma Aldrich), 1 PMSF, 2 N-ethylmaleimide, 05 PR-619 deubiquitinase inhibitor (LifeSensors). Cells were lysed on ice for 1 hr with intermittent vortexing and centrifuged at 10,000 g for 10 min (4° C.). The soluble lysate collected and protein concentration determined with the bis-cinchonic acid protein estimation kit (Pierce Technologies).

For Ca_(V)β_(1b) pulldowns, lysates were precleared with 10 μL of protein A/G sepharose beads (Rockland) for 1 hr at 4° C. and then incubated with 2 μg anti-Ca_(V)β₁ antibody (UC Davis/NIH NeuroMab Facility, clone N7/18) for 1 hr at 4° C. Equivalent amounts of protein were then added to spin columns with 25 μL equilibrated protein A/G sepharose beads and rotated overnight at 4° C. Immunoprecipitates were washed a total of five times with RIPA buffer and then eluted with 30 μL elution buffer (50 mM Tris, 10% (vol vol⁻¹) glycerol, 2% SDS, 100 mM DTT, and 0.2 mg mL⁻¹ bromophenol blue) at 55° C. for 15 min. For α_(1C) pulldowns, lysates were added to spin columns containing 10 μL of equilibrated RFP-trap agarose beads, rotated at 4° C. for 1 hr, and then washed/eluted as described above. Proteins were resolved on a 4-12% Bis Tris gradient precast gel (Life Technologies) in MOPS-SDS running buffer (Life Technologies) at 200 V constant for −1 hr. Protein bands were transferred by tank transfer onto a polyvinylidene difluoride (PVDF, EMD Millipore) membrane in transfer buffer (25 mM Tris pH 8.3, 192 mM glycine, 15% (vol/vol) methanol, and 0.1% SDS). The membranes were blocked with a solution of 5% nonfat milk (BioRad) in Tris-buffered saline-tween (TBS-T) (25 mM Tris pH 7.4, 150 mM NaCl, and 0.1% Tween-20) for 1 hr at RT and then incubated overnight at 4° C. with primary antibodies (Ca_(V)β₁, UC Davis/NIH NeuroMab Facility. Actin, Sigma Aldrich) in blocking solution. The blots were washed with TBS-T three times for 10 min each and then incubated with secondary horseradish peroxidase-conjugated antibody for 1 hr at RT. After washing in TBS-T, the blots were developed with a chemiluminiscent detection kit (Pierce Technologies) and then visualized on a gel imager. Membranes were then stripped with harsh stripping buffer (2% SDS, 62 mM Tris pH 6.8, 0.8% β-mercaptoethanol) at 50° C. for 30 min, rinsed under running water for 2 min, and washed with TBST (3×, 10 min). Membranes were pre-treated with 0.5% glutaraldehyde and re-blotted with anti-ubiquitin (VU1, LifeSensors) as per the manufacturers' instructions.

Calcium Imaging

DRG neurons were washed twice in basal solution containing (mM): 145 NaCl, 5 KCl, 2 CaCl₂, 1 MgCl2, one sodium citrate, 10 HEPES, 10 D-glucose, pH 7.4, and incubated in the same solution containing 5 uM fura-2 with 0.05% Pluronic F-127 detergent (Life Technologies) for 1 hr at 37° C., 5% CO₂. Afterwards, cells were washed twice in same solution and placed on an inverted Nikon Ti-eclipse microscope with a Nikon Plan fluor 20× objective (0.45 N.A.). Fura-2 measurements were recorded at excitation wavelengths of 340 and 380 nm using EasyRatioPro (HORIBA Scientific). DRG neurons were depolarized with a solution in which NaCl was reduced to 110 mM and KCl increased to 40 mM.

Pancreatic β-cells were imaged with a similar protocol. Cells were maintained in a basal KRBH solution composed of (mM): 134 NaCl, 3.5 KCl, 1.2 KH₂PO₄, 0.5 MgSO₄, 1.5 CaCl₂, 5 NaHCO₃, 10 HEPES, 2.8 D-glucose, pH 7.4. Stimulation solutions included either 16.8 mM glucose or 40 mM KCl, with NaCl concentrations adjusted accordingly to balance osmolarity with KRBH solution.

Data and Statistical Analysis

Data were analyzed off-line using FloJo, PulseFit (HEKA), Microsoft Excel, Origin and GraphPad Prism software. Statistical analyses were performed in Origin or GraphPad Prism using built-in functions. Statistically significant differences between means (p<0.05) were determined using Student's t test for comparisons between two groups or one-way ANOVA for three groups, with Tukey's post-hoc analysis. Data are presented as means±s.e.m.

Example 2 Isolation and Characterization of CaVβ-Targeted Nanobodies

The present disclosure developed a nanobody targeted to Ca_(V)βs that would be incorporated into Ca_(V) channel complexes but be functionally silent, to serve as a vehicle to potentially address distinct enzymatic moieties or sensors to endogenous channels. Ca_(V)β_(1b) and Ca_(V)β₃ were expressed in HEK293 cells using BacMam expression and purified the proteins using affinity purification, ion exchange, and size exclusion chromatography (FIG. 1A). Purified δ₁ and β₃ (1 mg each) were used for llama immunization, and successful serum conversion was confirmed by ELISA (not shown). Messenger RNA was extracted from isolated lymphocytes, PCR-amplified and cloned into a plasmid vector (pComb3XSS) to generate a V_(HHS) phage library (FIG. 1B). Putative nanobody binders were enriched from the phage library using three rounds of phage display and panning (Pardon et al., 2014). A 96-well ELISA was performed on enriched phage libraries and selected 14 positive clones for sequencing (FIG. 10). At least seven distinct classes of nanobody binders were identified based on the unique sequences within complementarity determining regions (CDR1-3), the major determinants of antigen binding (FIGS. 1D and 1E). Sequence information of twenty-five nanobodies identified was summaried below in Table 1.

A small-molecule-induced fluorescence co-translocation assay was adopted to simultaneously determine whether: (1) individual nanobodies were well-behaved when expressed in mammalian cells (i.e. do not aggregate), and (2) bound Ca_(V)βs. A tripartite construct consisting of individual nanobodies fused to CFP and the 01 domain of PKCγ was cloned into a CMV expression vector and transiently co-transfected with YFP-tagged Ca_(V)βs into HEK293 cells. After pilot experiments, we chose one nanobody clone, nb.F3, for in-depth characterization and development. Both nb.F3-CFP-C1 and YFP-β₁ were uniformly expressed in the cytosol of transfected HEK293 cells (FIG. 1F). Application of 1 μM phorbol-12,13-dibutyrate (PdBu) led to the rapid and dramatic redistribution of nb.F3-CFP-C1 from the cytosol to the plasma and nuclear membranes (FIG. 1F). Reassuringly, YFP-β₁ concomitantly redistributed to the plasma and nuclear membranes, providing a convenient visual confirmation that it associates with nb.F3 inside cells (FIG. 1F). Similar experiments conducted with the other Ca_(V)βs (β₂-β₄) showed that they all bind with nb.F3-CFP-C1 in cells (FIG. 1F, FIG. 7), indicating the nanobody interacts with an epitope conserved among Ca_(V)βs. Isothermal titration calorimetry using purified nb.F3 and Ca_(V)β_(2b) indicated a high-affinity (K_(d)=13.2±7.2 nM) interaction and a 1:1 stoichiometry (FIG. 1G).

It was important to the overall strategy that nb.F3 incorporate into assembled HVACC complexes without impacting channel function or subunit stability. A flow cytometry assay was used to assess the impact of nb.F3 on recombinant Ca_(V)2.2 trafficking, subunit expression levels, and whole-cell currents, all of which are known to be regulated by Ca_(V)13 (FIGS. 2A-2L) (Waithe et al., 2011). An engineered α_(1B) harboring two tandem high-affinity bungarotoxin-binding sites (2XBBS) in the extracellular domain IV S5-S6 loop and a C-terminus YFP tag was used to enable simultaneous detection of surface (Alexa647-conjugated bungarotoxin) and total (YFP fluorescence) channel populations in non-permeabilized cells (FIG. 2A). BBS-α_(1B)-YFP and Ca_(V)13 were co-expressed either with or without nb.F3-P2A-CFP and utilized flow cytometry to rapidly measure surface and total channel expression. In cells expressing BBS-α_(1B)-YFP and β_(1b), nb.F3 had no impact on Alexa647 or YFP fluorescence compared to control (FIGS. 2B-2D), indicating no disruption of channel trafficking or effect on α_(1B) expression. Similar results regarding the inertness of nb.F3 on α_(1B) trafficking and stability were obtained when Ca_(V)2.2 was reconstituted with the other Ca_(V)13 (δ₂-β₄) subunits (FIG. 2D).

To examine a potential direct impact of nb.F3 on Ca_(V)13 itself, the flow cytometry assay was applied to cells expressing BBS-α_(1B)+β-YFP±nb.F3-P2A-CFP (FIG. 2E). Not surprisingly, nb.F3 did not impact the surface trafficking of BBS-α_(1B) co-expressed with any of the four Ca_(V)β isoforms (FIGS. 2F-2H and FIGS. 8A-8F). The expression levels of β₁-YFP and β₄-YFP were unaffected by nb.F3, whereas the levels of β₂ and β₃ were modestly reduced (although this effect did not reach statistical significance), suggesting a possible slightly increased vulnerability of these two isoforms to degradation when bound by the nanobody (FIG. 2H). Similar observations regarding the lack of effect of nb.F3 on channel trafficking and subunit expression levels were made in cells expressing Ca_(V)1.2 channels reconstituted from BBS-α_(1C)+β-YFP±nb.F3-P2A-CFP (FIGS. 9A-9E).

Finally, patch-clamp electrophysiology was used to evaluate the impact of nb.F3 on whole-cell currents through recombinant Ca_(V)2.2 channels reconstituted in HEK293 cells. Cells expressing α_(1B)+β_(1b)+α₂δ displayed robust whole-cell Ba²⁺ currents that were completely unaffected by nb.F3 (FIG. 2I; I_(peak,0mV)=−104.4±22.0 pA/pF, n=10 for CFP, and I_(peak,0mV)=−103.5±39.5 pA/pF, n=10 for nb.F3). A similar lack of effect of nb.F3 was observed on currents from either Ca_(V)2.2 reconstituted with the other β₂-β₄ subunits (FIGS. 2J-2L), or Ca_(V)1.2 (α_(1C)+β_(2a)+α₂δ) channels (FIGS. 9A-9E).

Overall, these results indicate that nb.F3 binds β₁-β₄ subunits in cells, and is potentially assembled into Ca_(V) channel complexes in a functionally silent manner, essentially acting as an unobtrusive passenger. However, it was also possible that the apparent functional inertness of nb.F3 on Ca_(V)2.2 and Ca_(V)1.2 channels had a more trivial explanation—that Ca_(V)βs assembled with pore-forming al-subunits are simply inaccessible to nb.F3. We could discriminate between these two possible scenarios by determining whether nb.F3 could be used to target bioactive molecules to regulate assembled channels, as we did next.

TABLE 1 Summary of nanobodies generated. Bold Italics denotes nonconserved residues in Framework region (SCAA (VAA. (CAA. .xxx. xxx. xxx. MG) TYY) YD) CDR3 nb CDR1 CDR2 CDR3 # AA Full sequence b1. SGFTF

IEGMRI 18 QVQLQESGGGLVQPGGSL p1. DDYA FSSS SPVVT RLSCAVSGFTFDDYAIGWF A1 (SEQ DGS GIPAFD RQAPGKEREAVSCFSSSD ID (SEQ

GSTYYADSVKGRFTISSDN NO: ID (SEQ DKNMVYLQMNSLKPEDTAV 1) NO: ID YYCAAIEGMRISPVVTGIPA 2) NO: FDFGSWGQGTQVTVSS 3) (SEQ ID NO: 4) b1. SGRT ISWS DTYYG 27 QVQLQESGGGLVQAGGSV p1. FSSYT GG SRMWN RLSCAASGRTFSSYTMGW A7 (SEQ (SEQ E FRQAPGKEREFVAAISWSG ID ID (SEQ GTTYYADSVKGRFAIARDN NO: NO: ID AKNTAYLQMNSLKPEDTAV 5) 6) NO: YYCAADTYYGSRMWNEYD 7) YWGQGTQVTVSS (SEQ ID NO: 8) b1. SGSIL

ASS

13 QVQLQESGGGLVQPGGSL p1. TINV GGS YMRTE RLSCTASGSILTINVMGWYR D1 (SEQ (SEQ AQSRG QAPGKQRELVAHASSGGS ID ID TG TDYADSVKGRFTISRDNAK NO: NO: (SEQ NTWYLQMNNLKPEDTAVYY 9) 10) ID CTLYMRTEAQSRGTGYDY NO: WGQGTQVTVSS 11) (SEQ ID NO: 12) b1. SGRT IERSG SSYWS 27 QVQLQESGGGLVQAGGSV p1. FSSYA G RSVAE RLSCVASGRTFSSYAMGW D8 (SEQ

(SEQ FRQAPGKEREFVAAIERSG ID (SEQ ID GTASHADSVKGRFTISRDN NO: ID NO: AKNTVYLQMNSLKPEDTAV 13) NO: 15) YSCAASSYWSRSVAEYDY 14) WGQGTQVTVSS (SEQ ID NO: 16) b1. SERTF INWS HYQGS 28 QVQLQESGGGLVQAGGSL p1. SRYA GSS YGSALA RLSCAASERTFSRYAMGW D1 (SEQ (SEQ (SEQ FRQAPEKEREFVAAINWSG 2 ID ID ID SSTYYADSVKGRFTVSRDD NO: NO: NO: AKNTVYLQMNSLKPEDTAV 17) 18) 19) YYCAAHYQGSYGSALAYDI WGQGTQVTVSS (SEQ ID NO: 20) b1. SERTF INWS HYQGS 28 QVQLQESGGGLVQAGGSL p2. SRYA GSS YGSALA RLSCAASERTFSRYAMGW A1 (SEQ (SEQ (SEQ FRQAPEKEREFVAAINWSG 1 ID ID ID SSTYYADSVKGRFTVSRDD NO: NO: NO: AKNTVYLQMNSLKPEDTAV 21) 22) 23) YYCAAHYQGSYGSALAYDT WGQGTQVTVSS (SEQ ID NO: 24) b1. SGRT ISWS

19 QVQLQESGGGSVQAGGSL p2. FSRN GRN GADWR RLSCAASGRTFSRNAMGW C4 A (SEQ VYDES FRQAPGKEREFVAAISWSG (SEQ ID YYSTAH RNTYYADSVKGRFTISRDN ID NO: Y 

AKNTLSLQMNSLKPEDSAV NO: 26) (SEQ YICAVGADWRVYDESYYST 25) ID AHYYEYWGQGTQVTVSS NO: (SEQ ID NO: 28) 27) b1. SGRT IERSG SSYWS 27 QVQLQESGGGLVQGGGSR p2. FSSYA G RSVDE RFSCAASGRTFSSYAMGW D1 (SEQ

(SEQ FRQAPGKEREFVAAIERSG ID (SEQ ID GTASHADSKKGRFTISRDN NO: ID NO: TKNTVYQQMNSKKPEDTAV 29) NO: 31) YYCAASSYWSRSVDEYDY 30) WGQGTQVTVSS (SEQ ID NO: 32) b1. SERTF INWS HYQGS 28 QVQLQESGGGLVQAGGSL p3. SRYA GSS YGSAS RLSCAASERTFSRYAMGW D1 (SEQ (SEQ A FRQAPEKEREFVAAINWSG ID ID (SEQ SSTYYADSVKGRFTVSRDD NO: NO: ID AKNTVNLEMNSLKPEDTAV 33) 34) NO: YYCAAHYQGSYGSASAYDT 35) WGQGTQVTVSS (SEQ ID NO: 36) b1. SGRT ITWS

13 QVQLQESGGGLVQAGGSL p.D FSPYA GGL DDDTF RLSCAASGRTFSPYAMGW 10 (SEQ (SEQ GVTTST FRQAPGKEREFVAAITWSG ID ID H GLTYYADSVKGRFTISRDN NO: NO: (SEQ SKNTVSLQMNSLKPEDTAV 37) 38) ID YYCALDDDTFGVTTSTHYD NO: YWGQGTQVTVSS 39) (SEQ ID NO: 40) b1. SGRT

19 QVQLQESGGGSVQAGGSL p3. FSKN ISWS GGDWR RLSCAASGRTFSKNAMGW E8 A GRN VYDISF FRQAPGKEREFVVAISWSG (SEQ (SEQ YYTAH RNTYYADSVKGRFTISRDN ID ID Q 

AKNTVDLQMNSLKPEDSAV NO: NO: (SEQ YYCAVGGDWRVYDISFYYT 41) 42) ID AHQYEYWGQGTQVTVSS NO: (SEQ ID NO: 44) 43) b1. SLGTF

EVFYS 35 QVQLQESGGGLVQAGGSL p3. SRYA ISWS GSYDD RLSCAASLGTFSRYAMGWF E1 (SEQ GGS TLRVQS RQAPGKEREFVSAISWSGG 1 ID

HE STLYADSVKGRFAISRDNAK NO: (SEQ (SEQ NTVYLQMNSLKPEDTAVYY 45) ID ID CAAEVFYSGSYDDTLRVQS NO:  NO: HEYDYWGQGTQVTVSS 46) 47) (SEQ ID NO: 48) b1. SGRT ISWS DTYYG 28 QVQLQESGGGLVQAGGSL p3. FSSYT GGT SRMWN RLSCAASGRTFSSYTMGW F1 (SEQ (SEQ E FRQAPGKEREFVAAISWSG ID ID (SEQ GTTYYADSVKGRFAIARDN NO: NO: ID AKNTAYLQMNSLKPEDTAV 49) 50) NO: YYCAADTYYGSRMWNEYD 51) YWGQGTQVTVSS (SEQ ID NO: 52) b1. SERTF INWS

 0 QVQLQESGGGLVQAGGSL ne SRYA GSS RLSCAASERTFSRYAMGW g.p (SEQ (SEQ FRQAPEKEREFVAAINWSG 1.F ID ID SSTYYADSVKGRFTVSS 4 NO: NO: (SEQ ID NO: 55) 53) 54) b1. SGRT INWS

 0 QVQLQESGGGSVQAGGSL ne FSRN GSS RLSCAASGRTFSRNAMGW g.p A (SEQ FRQAPGKEREFVAAINWSG 1.G (SEQ ID SSTYYADSVKGRFTVSS 9 ID NO: (SEQ ID NO: 58) NO: 57) 56) b1. SERTF INWS HYQGS 28 QVQLQESGGGLVQAGGSL ne SRYA GSS YGSAS RLSCAASERTFSRYAMGW g.p (SEQ (SEQ A FRQAPEKEREFVAAINWSG 1.G ID ID (SEQ SSTYYADSVKGRFTVSRDD 8 NO: NO: ID AKNTVNLEMNSLKPEDTAV 59) 60) NO: YYCAAHYQGSYGSASAYDT 61) WGQGTQVTVSS (SEQ ID NO: 62) b1. SGFS

VVGLR 20 QVQLQESGGGLVQAGGSL ne FDDY ISSSD LPTYA RLSCAASGFSFDDYTLGWF g.p T 

GS SNSCK RQAPGKEREGVSCISSSDG 1.H (SEQ (SEQ IVAD STYYADSVKGRFTISSGNA 11 ID ID

KNTVYLQMNSLKPEDTAVY NO: NO: (SEQ YCAAVVGLRLPTYASNSCKI 63) 64) ID VADFGSWGQGTQVTVSS NO: (SEQ ID NO: 66) 65) b1.

IDWS

19 QVQLQESGGGLVQAGGSL ne SGRT GG GGDW RLSCVASGRTFSSYAMGW g.p FSSYA

RVYDI FRQAPGKEREFVAAIDWSG 1.H (SEQ (SEQ SFYYT GTASHADSVKGRFTISRDN 12 ID ID AHQ AKNTVDLQMNSLKPEDSAV NO: NO:

YYCAVGGDWRVYDISFYYT 67) 68) (SEQ AHQYEYWGQGTQVTVSS ID (SEQ ID NO: 70) NO: 69) b1. SGRT ISWS HYQGS 28 QVQLQESGGGSVQAGGSL ne FSRN GRN YGSAL RLSCAASGRTFSRNAMGW g.p A (SEQ A FRQAPGKEREFVAAISWSG 1.C (SEQ ID (SEQ RNTYYADSVKGRFTVSRDD 5 ID NO: ID AKNTVYLQMNSLKPEDTAV NO: 72) NO: YYCAAHYQGSYGSALAYDT 71) 73) WGQGTQVTVSS (SEQ ID NO: 74) b1. SGRT ITWSR GLWR 33 QVQLQESGGGLVQAGGSL ne FSNFA GS YYTES RLSCAASGRTFSNFAMGW g.p (SEQ (SEQ YFYTE FRQAPGKEREFVAAITWSR 1.G ID ID DR GSTYYTDSVKGRFTISRDN 7 NO: NO: (SEQ AKNTGYLQMNSLKPEDSAV 75) 76) ID YYCAAGLWRYYTESYFYTE NO: DRYDYWGQGTQVTVSS 77) (SEQ ID NO: 78) b3.

THEQV 36 QVQLQESGGGLVQPGGSL p3. SGFTL ISSSD WKTLF RLSCAVSGFTLDNYAIGWF A8 DNYAI GS SSCTV RQAPGKEREGVSCISSSDG (SEQ (SEQ ERDD STYYADSVKGRFTISSDND ID ID (SEQ KNMVYLQMNSLKPEDTAVY NO: NO: ID YCATHEQVWKTLFSSCTVE 79) 80) NO: RDDYDYWGQGTQVTVSS 81) (SEQ ID NO: 82) b3.

IDWS SSYWS 27 QVQLQESGGGLVQAGGSL p3. SGRT GG RSVDE RLSCVASGRTFSSYAMGW F3 FSSYA

(SEQ FRQAPGKEREFVAAIDWSG (SEQ (SEQ ID GTASHADSVKGRFTISRDN ID ID NO: AKNTVYLQMNSLKPEDTAV NO: NO: 85) YYCAASSYWSRSVDEYDY 83) 84) WGQGTQVTVSS (SEQ ID NO: 86) b3. SGFTL

THEQV 36 dif- QVQLQESGGGLVQPGGSL p3. DNYA ISSSD WKTLF fers RLSCAASGFTLDNYAIGWF B1

GS SSCTV from RQAPGKEREGVSCISSSDG 1 (SEQ (SEQ ERDD b3. STYYADSVKGRFTISRDNA ID ID (SEQ p3.A KNTAYLQLNSLKPEDTAVY NO: NO: ID 8 in YCATHEQVWKTLFSSCTVE 87) 88) NO: FW RDDYDYWGQGTQVTVSS 89) (SEQ ID NO: 90) b3. SGFTL

THEQV 36 dif- QVQLQESGGGLVQAGGSL p3. DNYA ISSSD WKTLF fers RLSCAASGFTLDNYAIGWF G1 IG GS SSCTV from RQAPGKEREGVSCISSSDG (SEQ (SEQ ERDD b3. STYYADSVKGRFTISRDNA ID ID (SEQ p3.B KNTAYLQLNSLKPEDTAVY NO: NO: ID 11 YCATHEQVWKTLFSSCTVE 91) 92) NO: in RDDYDYWGQGTQVTVSS 93) FW1 (SEQ ID NO: 94) b3. SGRT IDWS TSYWS 27 QVQLQESGGGLVQAGGSL p3. FSSYA GG TAEYE RLSCAASGRTFSSYAMGW G4 (SEQ

(SEQ FRQTPGKEREFVAAIDWSG ID (SEQ ID GTSVHADSVKGRFTIARDN NO: ID NO: AKNTVYLQMSSLKPEDTAT 95) NO: 97) YYCAATSYWSTAEYEYDY 96) WGQGTQVTVSS (SEQ ID NO: 98)

Example 3 Potent Functional Effects of an F3-Nedd4L Chimeric Protein on CaV1/CaV2 Channels

It was hypothesized that fusing the catalytic domain of an E3 ubiquitin ligase to nb.F3 would generate a genetically-encoded molecule that inhibits Cav1/Cav2 channels by reducing their surface density (Kanner et al., 2017). Accordingly, a chimeric construct (nb.F3-Nedd4L) was generated by fusing the catalytic HECT domain of Nedd4L to the C-terminus of nb.F3. We also generated a catalytically dead mutant of the chimeric construct (nb.F3-Nedd4L[C942S]) to distinguish between ubiquitination-dependent and independent effects. Both constructs were generated in a P2A-CFP expression vector, enabling use of CFP fluorescence to confirm protein expression.

In experiments mimicking those described for nb.F3, the impact of nb.F3-Nedd4L and nb.F3-Nedd4L[C942S] on reconstituted Ca_(V)2.2 channel trafficking, subunit expression levels, and whole-cell currents (FIGS. 3A-3J) was examined. Given the classical role of E3 ubiquitin ligases in mediating degradation of target proteins, it was first assessed if nb.F3-Nedd4L affected total Ca_(V)β expression (FIGS. 3A and 3B). In cells expressing BBS-α_(1B)+β_(1b)-YFP+α₂δ, neither F3-Nedd4L nor F3-Nedd4L[C942S] had any significant impact on 131b total expression as reported by the unchanged YFP fluorescence compared to negative control cells (FIGS. 3A and 3B). Similar results were obtained when BBS-α_(1B) was reconstituted with YFP-tagged β₂, β₃, or β₄ subunits, though there was a trend towards lower fluorescence with β_(2a) and β₄ (FIG. 3B). By contrast, nb.F3-Nedd4L significantly suppressed surface density of BBS-α_(1B) irrespective of the identity of the co-expressed YFP-tagged Ca_(V)β (FIG. 3C, red bars; FIGS. 10A-10H). The decreased BBS-α_(1B) surface density was not observed with nb.F3-Nedd4L[C942S] (FIG. 3C, green bars), indicating it requires the catalytic activity of the attached Nedd4L HECT domain. Similarly, in cells expressing BBS-α_(1C)+β_(X)-YFP, nb.F3-Nedd4L strongly reduced Ca_(V)1.2 surface density in a ubiquitin-dependent manner (FIGS. 11A-11D).

Given the striking effect of nb.F3-Nedd4L on surface population of channels without affecting total levels Ca_(V)β, it was next assessed whether there was any impact of nb.F3-Nedd4L on total α_(1B) subunit expression. Similar to our observations for Ca_(V)β, nb.F3-NeddL had no significant impact on the expression of BBS-α_(1B)-YFP (FIG. 3E, red bars) relative to either negative controls (black bars) or cells expressing nb.F3-Nedd4L[C942S] (green bars). Not surprisingly, nb.F3-Nedd4L markedly impaired surface trafficking of BBS-α_(1B)-YFP co-expressed with any Ca_(V)β (FIG. 3F).

Finally, the functional impact of nb.F3-Nedd4L on reconstituted Ca_(V)2.2 whole-cell currents was examined. Remarkably, nb.F3-Nedd4L essentially eliminated Ca_(V)2.2 currents reconstituted from α_(1B)+α₂δ co-expressed with any of the four Ca_(V)βs (FIGS. 3G-3J). Further, nb.F3-Nedd4L was equally effective in ablating whole-cell currents in reconstituted Ca_(V)1.2, Ca_(V)1.3, Ca_(V)2.1, and Ca_(V)2.3 channels (FIGS. 4A-4D).

Given its exceptional efficacy in ablating whole-cell HVACC currents via a functionalized Ca_(V)β-targeted nanobody, we named nb.F3-Nedd4L as Ca_(V)-aβlator, and describe the process of HVACC current elimination by this molecule as Ca_(V)-aβlation.

Example 4 CaV-aβlation of Endogenous CaV1.2 Channels in Cardiomyocytes

It was next determined whether Ca_(V)-aβlator could effectively inhibit HVACC currents in native cells where the nano-environment around Ca_(V)1/Ca_(V)2 channels is typically more complex than in heterologous cells. Cultured adult guinea pig ventricular cardiomyocytes (CAGPVCs) provided an initial exceptional challenge because they have an intricate cyto-architecture and express Ca_(V)1.2 channels that are predominantly targeted to specialized dyadic junctions. Moreover, as it has now been shown that in adult cardiomyocytes binding of α_(1C) to Ca_(V)β is not obligatory for substantive Ca_(V)1.2 channel trafficking to the surface sarcolemma (Yang et al., 2019; Meissner et al., 2011), the fraction of Ca_(V)β-bound Ca_(V)1.2 channels contributing to the whole-cell L-type current (I_(Ca,L)) in ventricular myocytes is ambiguous. Adenovirus was used to express Ca_(V)-aβlator or nb.F3-Nedd4L[C942S] in CAGPVCs which retain the rod-shaped phenotype and overall cyto-architecture of freshly isolated heart cells (FIG. 5A). Control (non-infected) cardiomyocytes expressed I_(Ca,L) that peaked at a 0 mV test pulse (FIGS. 5A and 5B; I_(peak,0mV)=−6.5±0.2 pA/pF, n=8). By contrast, in contemporaneous experiments, cardiomyocytes expressing Ca_(V)-aβlator via adenovirus-mediated infection displayed virtually no Ca_(V)1.2 currents, demonstrating an exceptional Ca_(V)-aβlation efficiency in this system (FIGS. 5A and 5B; I_(peak,0mV)=−1.0±0.3 pA/pF, n=9). Cardiomyocytes expressing nb.F3-Nedd4L[C942S] displayed I_(Ca,L) similar to control (I_(peak,0mV)=−5.1±0.6 pA/pF, n=10), indicating that ubiquitination is necessary for Ca_(V)-aβlation in this system.

What is the mechanism of Ca_(V)-aβlation in cardiomyocytes? Immunofluorescence was used to probe how Ca_(V)-aβlator affected expression levels and sub-cellular localization of Ca_(V)1.2 α_(1C) and β₂ subunits, respectively, in cardiomyocytes. Ca_(V)α_(1C) in uninfected cardiomyocytes presented with a characteristic striated punctate distribution pattern that co-localized with that of ryanodine (RyR2) receptors (FIG. 5C), reflecting their well-known predominant localization at dyadic junctions (Scriven et al., 2000; Bers, 2002). A similar distribution pattern for α_(1C) was observed in cardiomyocytes expressing nb.F3-Nedd4L[C942S], consistent with the lack of effect of this protein on I_(Ca,L). In cardiomyocytes expressing Ca_(V)-aβlator, the signal intensity for punctate α_(1C) staining was unchanged from control cells (FIGS. 12A-12D), suggesting no impact of the presumed increase in ubiquitination on the stability of the protein. However, there was a redistribution of α_(1C) from dyadic junctions, as reported by a dramatic loss of co-localization between α_(1C) and RyR2 (FIG. 5C). Rather, the punctate α_(1C) signals in Ca_(V)-aβlator-expressing cardiomyocytes coincided with Rab7, but not Rab5 or LAMP1, immunofluorescence signals (FIG. 5D; FIGS. 12A-12D). Thus, the mechanism of Ca_(V)-aβlator inhibition of I_(Ca,L) is redistribution of α_(1C) from dyadic junctions to intracellular compartments, specifically Rab7-positive late endosomes (FIG. 5H) (Rink et al., 2005).

Cardiomyocytes expressing Ca_(V)-aβlator also showed no difference in total Ca_(V)β₂ levels as compared to either uninfected or nb.F3-Nedd4L[C942S]-expressing cells (FIGS. 12A-12D). Hence, Ca_(V)-aβlator-mediated redistribution of Ca_(V)1.2 in cardiomyocytes cannot be explained as simply due to an absence of Ca_(V)β. An intriguing possibility was that though Ca_(V)-aβlator is specifically targeted to Ca_(V)β in channel complexes, it is also able to directly catalyze ubiquitination of α₁ subunits within the macro-molecular complex. Indeed, in pulldown experiments of recombinant Ca_(V)1.2 channels, Ca_(V)-aβlator substantially increased ubiquitination of both α_(1C) (FIGS. 5E and 5F) and Ca_(V)β_(1b) subunits (FIG. 5G). Nevertheless, the overall levels of α_(1C) expression was unchanged with Ca_(V)-aβlator despite the increased ubiquitination (FIG. 5E). Taken together, our results suggest that direct ubiquitination of α_(1C) by Ca_(V)-aβlator may underlie the redistribution of Ca_(V)1.2 channels from dyads to Rab7-positive late endosomes (FIG. 5H).

Example 5 CaV-aβlation in Dorsal Root Ganglion (DRG) Neurons and Pancreatic β Cells

It was next tested the efficacy of Ca_(V)-aβlator to suppress HVACCs in murine dorsal root ganglion (DRG) neurons which were of interest because they express multiple Ca_(V)1/Ca_(V)2 channel types (Murali et al., 2015; McCallum et al., 2011), and also play a key role in the processing of noxious signals including pain and itch (Han et al., 2013; Kim et al., 2016). Cultured DRG neurons were infected with adenovirus expressing either GFP, Ca_(V)-aβlator, or nb.F3-Nedd4L[C942S]. Given their heterogeneous nature, fura-2 was first used to measure calcium influx into a population of DRG neurons in response to depolarization with 40 mM KCl (FIGS. 6A and 6B). Recordings were done in the presence of 5 μM mibefradil to block low-voltage-activated T-type calcium channels which are also prevalent in these cells (Puckerin et al., 2018; Jagodic et al., 2008). In neurons expressing GFP or nb.F3-Nedd4L[C942S], a substantial fraction of cells displayed large increases in fura-2-reported Ca²⁺ transients in response to 40 mM KCl, indicating the opening of Ca_(V)1/Ca_(V)2 channels (FIGS. 6A and 6B). By contrast, depolarization-induced Ca²⁺ influx was virtually eliminated in neurons expressing Ca_(V)-aβlator, demonstrating highly efficient Ca_(V)-ablation in this system (FIGS. 6A and 6B).

Whole-cell patch clamp was used to further characterize the impact of Ca_(V)-aβlator on calcium currents in DRG neurons. It was of particular interest to determine relative effects of Ca_(V)-aβlator on HVACCs and LVA T-type channels that are present in a subset of DRG neurons. We recorded families of whole-cell currents evoked by test pulses (from −40 mV to +60 mV in 10 mV increments) from a holding potential of either −90 mV or −50 mV to inactivate any T-type channel present (FIG. 6C). Cells expressing GFP (control) or F3-Nedd4L[C942S] displayed large I_(Ba) irrespective of the holding potential (FIGS. 6C and 6D; I_(peak,−10mV)=−173.9±28.2 pA/pF, n=6 for GFP, I_(peak,−10mv)=−206.7±36.4 pA/pF, n=5 for F3-Nedd4L[C942S]), though those recorded with a −50 mV holding potential had a lower amplitude reflecting inactivation of T-type channels and also a fraction of HVACCs. Cells expressing Ca_(V)-aβlator displayed essentially no HVACC currents (FIGS. 6C and 6D; I_(peak,−10mV)=−14.3±6.2 pA/pF), most evident as an absence of I_(Ba) recorded from a −50 mV holding potential (FIG. 6C, middle). Moreover, in these cells, when currents were recorded from a −90 mV holding potential, they displayed fast inactivation kinetics characteristic of T-type channels (FIG. 6C). Overall, these results indicate Ca_(V)-ablator selectively eliminates HVACCs in DRG neurons without impacting LVA T-type channels.

Finally, it was tested whether Ca_(V)-ablator is also effective in murine pancreatic δ-cells, which have multiple Ca_(V) channel types (Ca_(V)1.2, Ca_(V)1.3, and Ca_(V)2.1) involved in insulin release (Yang and Berggren, 2006). Adenovirus was used to infect digested islets isolated from transgenic mice expressing tdTomato in pancreatic β-cells. Control cells expressing GFP or nb.F3-Nedd4L[C942S] displayed robust glucose- or KCl-evoked fura-2-reported Ca²⁺ transients that were essentially abolished in cells expressing Ca_(V)-aβlator (FIGS. 6E-6G). Altogether, these results reveal the exceptional activity of Ca_(V)-aβlator as a genetically-encoded HVACC inhibitor that is effective across diverse cellular contexts.

Example 6 Discussion

The present disclosure introduces Ca_(V)-aβlator as a novel genetically-encoded molecule that potently inhibits HVACCs by targeting auxiliary Ca_(V)β subunits. Ca_(V)-aβlator combines the exquisite specificity of a Ca_(V)β-targeted nanobody and the powerfully consequential catalytic activity of an E3 ubiquitin ligase. Four distinct aspects of the present disclosure were discussed, based on viewing Ca_(V)-aβlator from different perspectives; 1) as a unique tool to selectively erase HVACCs in cells, 2) as a method to probe mechanisms of HVACC regulation and trafficking, 3) as a potential therapeutic, and 4) as a prototype engineered protein that enables probing new dimensions of macro-molecular membrane protein signaling.

Ca²⁺ is a universal second messenger critical to the biology of virtually all cells. In excitable cells, both LVACCs and HVACCs transduce electrical signals encoded in action potentials into changes in intracellular Ca²⁺ that then drive many biological responses. In cells expressing both classes of channels, the physiological effects mediated specifically through LVACCs versus HVACCs in vivo can be difficult to decipher. Ca_(V)-aβlator now presents as a tool that can be deployed in target cells to virtually erase all HVACCs while leaving LVACC actions intact. The closest existing proteins that can similarly eliminate HVACCs are RGK GTPases which are capable of potently inhibiting Ca_(V)1/Ca_(V)2 channels when over-expressed in target cells (Murata et al., 2004; Chen et al., 2005; Xu et al., 2010; Puckerin et al., 2018; Bannister et al., 2008). However, a distinct disadvantage of RGKs is their propensity for off-target effects due to their known interactions with, and regulation of, cytoskeletal proteins and other signaling molecules including 14-3-3, calmodulin, and CaM kinase II (Yang and Colecraft, 2013; Correll et al., 2008; Royer et al., 2018; Béguin et al., 2005). Over the last two decades, several groups have sought to disrupt the α₁-Ca_(V)β interaction with either small molecules or by over-expressing the AID peptide as a Ca_(V)β sponge (Findeisen et al., 2017; Chen, 2018; Khanna et al., 2019; Yang et al., 2019). While this approach has shown some efficacy in certain instances, the potency of HVACC inhibition falls well short of that achieved here with Ca_(V)-aβlator. Indeed, over-expressing the AID peptide in adult cardiac myocytes is not effective in inhibiting Ca_(V)1.2 channels (Yang et al., 2019), because in this context α_(1C) binding to Ca_(V)β is not absolutely required for channel trafficking to the surface (Yang et al., 2019; Meissner et al., 2011). Nevertheless, the ability of Ca_(V)-aβlator to essentially eradicate I_(Ca,L) in adult cardiomyocytes indicates that under normal physiological conditions essentially all α_(1C) subunits are associated with a Ca_(V)β in ventricular heart cells.

Ca_(V)1/Ca_(V)2 channels and other surface membrane proteins spend a significant portion of their life cycles in intracellular compartments reflecting their biogenesis, recycling, and ultimate destruction. The signals regulating HVACC degradation and trafficking among compartments are arcane and poorly understood, but likely prominently involve post-translational modifications of channel subunits. Here, we show that targeted ubiquitination of α_(1C)/β₂ complexes in cardiomyocytes with Ca_(V)-aβlator specifically arrests Ca_(V)1.2 channels in Rab7-positive late endosomes. Ca_(V)-aβlator possesses the catalytic HECT domain of Nedd4L which is known to principally catalyze the addition of K63-linkage polyubiquitin chains to target proteins (Kim and Huibregtse, 2009; Scheffner and Kumar, 2014). Thus, our results suggest that K63-ubiquitin chains on α_(1C)/β₂ subunits may be a key signal directing Ca_(V)1.2 channels to late endosomes. We further found that targeted ubiquitination of HVACC α₁ subunits with Ca_(V)-aβlator did not lead to their enhanced degradation either in heterologous cells or cardiomyocytes. By contrast, using a GFP nanobody to target the Nedd4L HECT domain to YFP-tagged KCNQ1, a known substrate of endogenous Nedd4L, resulted in reduced expression of this K⁺ channel pore-forming α₁ subunit (Kanner et al., 2017). Hence, the impact of Nedd4L HECT domain on the stability of membrane proteins is likely substrate-dependent. We speculate that arming nb.F3 with the catalytic domains of other types of E3 ligases that catalyze formation of different polyubiquitin chains will elucidate the precise signals dictating Ca_(V)1/Ca_(V)2 channel degradation and trafficking among distinct compartments. Beyond ubiquitination, the approach could also be potentially used to elucidate functional consequences and mechanisms of other post-translational modifications such as phosphorylation/dephosphorylation on Ca_(V)1/Ca_(V)2 channels, as well as to localize sensors that report on signals within HVACC nano-domains in live cells.

Blocking the activity of specific HVACCs with small molecules is a prevailing or potential therapy for many cardiovascular and neurological diseases including; pain, hypertension, cardiac arrhythmias, epilepsy, and Parkinson's disease (Zamponi, 2016). A limitation of small molecule or toxin blockers for HVACCs is the propensity for off-target effects due to their inevitable widespread distribution when administered to a patient. In some circumstances such off-target effects may limit the therapeutic window sufficiently to adversely affect treatment efficacy. Genetically-encoded HVACC inhibitors have great potential to be useful therapeutics with the advantage that their expression can be restricted to target tissues/cell types, or even to spatially discrete channels within single cells (Murata et al., 2004; Makarewich et al., 2012). Given its potency in silencing HVACC activity, Ca_(V)-aβlator could be a lead molecule for future development into a gene therapy for particular applications where a genetically-encoded HVACC inhibitor is warranted. For this purpose, it may be desirable to generate Ca_(V)-aβlator versions whose time course and extent of action could be tuned by either a small molecule or light. Indeed, this is a focus of ongoing work.

Finally, an exciting prospect is the potential of Ca_(V)-aβlator as a prototype that can be further developed to engineer proteins that regulate Ca_(V)1/Ca_(V)2 channel complexes with new dimensions of specificity. For example, a prevailing idea is that Ca_(V)1/Ca_(V)2 channels of a particular type (e.g. Ca_(V)1.2 channels in cardiomyocytes) may yet form discrete signaling units with different functional outputs in single cells based on their incorporation into divergent macro-molecular complexes (Shaw and Colecraft, 2013). There are tantalizing hints that different Ca_(V)β isoforms could be a node of signal diversification by promoting formation of molecularly distinct HVACC macro-molecular complexes (McEnery et al., 1998; Brice and Dolphin, 1999; Campiglio and Flucher, 2015). Hence, the ability to inhibit specific Ca_(V) channel macro-molecular complexes based on the identity of the constituent Ca_(V)β is biologically important, yet not rigorously addressable with conventional knockout/knockdown approaches. However, this capability may be readily achieved with Ca_(V)-aβlators directed towards particular Ca_(V)β isoforms. A challenge to realize this possibility is the development of Ca_(V)β isoform-specific nanobodies which should be feasible given that there is sequence divergence among Ca_(V)βs outside the conserved src homology 3 (SH3) and guanylate kinase (GK) domains (Buraei and Yang, 2010). In a broader context, the phenomenon of ion channel pore-forming α₁ subunits assembled with diverse auxiliary subunits in individual cells is common throughout biology (O'Malley and Isom, 2015; Copits and Swanson, 2012; Trimmer, 2015). Hence, Ca_(V)-aβlator-inspired molecules and approaches might be expected to elucidate functional dimensions of ion channel macro-molecular complex signaling that, to date, have remained refractory to analyses.

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All documents cited in this application are hereby incorporated by reference as if recited in full herein.

Although illustrative embodiments of the present disclosure have been described herein, it should be understood that the disclosure is not limited to those described, and that various other changes or modifications may be made by one skilled in the art without departing from the scope or spirit of the disclosure. 

What is claimed is:
 1. A nanobody capable of binding to a Ca_(V)β auxiliary subunit, comprising SEQ ID NOs: 1-3, SEQ ID NOs: 5-7, SEQ ID NOs: 9-11, SEQ ID NOs: 13-15, SEQ ID NOs: 17-19, SEQ ID NOs: 21-23, SEQ ID NOs: 25-27, SEQ ID NOs: 29-31, SEQ ID NOs: 33-35, SEQ ID NOs: 37-39, SEQ ID NOs: 41-43, SEQ ID NOs: 45-47, SEQ ID NOs: 49-51, SEQ ID NOs: 53-54, SEQ ID NOs: 56-57, SEQ ID NOs: 59-61, SEQ ID NOs: 63-65, SEQ ID NOs: 67-69, SEQ ID NOs: 71-73, SEQ ID NOs: 75-77, SEQ ID NOs: 79-81, SEQ ID NOs: 83-85, SEQ ID NOs: 87-89, SEQ ID NOs: 91-93, or SEQ ID NOs: 95-97.
 2. The nanobody of claim 1, comprising SEQ ID NO: 4, SEQ ID NO: 8, SEQ ID NO: 12, SEQ ID NO: 16, SEQ ID NO: 22, SEQ ID NO: 26, SEQ ID NO: 30, SEQ ID NO: 34, SEQ ID NO: 38, SEQ ID NO: 42, SEQ ID NO: 46, SEQ ID NO: 48, SEQ ID NO: 52, SEQ ID NO: 55, SEQ ID NO: 58, SEQ ID NO: 62, SEQ ID NO: 66, SEQ ID NO: 70, SEQ ID NO: 74, SEQ ID NO: 78, SEQ ID NO: 82, SEQ ID NO: 86, SEQ ID NO: 90, SEQ ID NO: 94, or SEQ ID NO:
 98. 3. A composition comprising: (i) a nanobody according to any one of claims 1-2; and (ii) a catalytic domain of an E3 ubiquitin ligase operably connected to the nanobody.
 4. The composition of claim 3, wherein the composition is effective to remove a High-Voltage Activated Calcium Channel (HVACC) from its functional location on a plasma membrane of a cell.
 5. The composition of claim 4, wherein the HVACC is selected from the group consisting of Ca_(V)1.1, Ca_(V)1.2, Ca_(V)1.3, Ca_(V)1.4, Ca_(V)2.1, Ca_(V)2.2, Ca_(V)2.3, and combinations thereof.
 6. The composition of claim 5, wherein the HVACC is one or more of Ca_(V)1.2, Ca_(V)1.3, Ca_(V)2.1, and Ca_(V)2.3.
 7. The composition of claim 4, wherein the composition is effective to achieve functional knockdown of the HVACC.
 8. The composition of claim 4, wherein the E3 ubiquitin ligase comprises the catalytic domain of Nedd4-2.
 9. The composition of claim 4, wherein the composition is effective to impair the function of a Ca_(V)β auxiliary subunit of trafficking the HVACC to the plasma membrane.
 10. The composition of claim 4, wherein the composition is effective to abolish surface levels of all HVACCs.
 11. The composition of claim 4, wherein the composition is effective to reduce or eliminate HVACC currents.
 12. A composition comprising a genetically encoded calcium channel blocker comprising a nucleic acid encoding: (i) a nanobody according to any one of claims 1-2; and (ii) a catalytic domain of an E3 ubiquitin ligase.
 13. The composition of claim 12, wherein the E3 ubiquitin ligase comprises a catalytic domain of Nedd4-2.
 14. The composition of claim 12, wherein the nanobody and the catalytic domain of the E3 ubiquitin ligase are functionally linked.
 15. The composition of claim 12, wherein the nanobody and the catalytic domain of the E3 ubiquitin ligase are expressed to form a contiguous polypeptide.
 16. The composition of claim 15, wherein the contiguous polypeptide is effective to remove a High-Voltage Activated Calcium Channel (HVACC) from its functional location on a plasma membrane of a cell.
 17. The composition of claim 16, wherein the HVACC is selected from the group consisting of Ca_(V)1.1, Ca_(V)1.2, Ca_(V)1.3, Ca_(V)1.4, Ca_(V)2.1, Ca_(V)2.2, Ca_(V)2.3, and combinations thereof.
 18. The composition of claim 17, wherein the HVACC is one or more of Ca_(v)1.2, Ca_(v)1.3, Ca_(v)2.1, and Ca_(v)2.3.
 19. The composition of claim 15, wherein the contiguous polypeptide is effective to achieve functional knockdown of a HVACC in the cell.
 20. The composition of claim 15, wherein the contiguous polypeptide is effective to impair the function of a Ca_(V)β auxiliary subunit of trafficking a HVACC to the plasma membrane.
 21. The composition of claim 15, wherein the contiguous polypeptide is effective to abolish surface levels of all HVACCs.
 22. The composition of claim 15, wherein the contiguous polypeptide is effective to reduce or eliminate HVACC currents.
 23. The composition of claim 12, wherein the nucleic acid encoding (i) and (ii) is carried on an expression vector.
 24. The composition of claim 23, wherein the expression vector further comprises a tissue specific promoter.
 25. A method of blocking a High-Voltage Activated Calcium Channel (HVACC) in a cell, comprising contacting the cell with an effective amount of a composition according to any one of claims 3-24.
 26. The method of claim 25, wherein the cell is a neuron or a cardiac myocyte.
 27. A method of selectively targeting a population of cells in a subject, comprising administering to the subject an effective amount of a composition according to any one of claims 3-24.
 28. The method of claim 27, wherein the cells are neurons that mediate pain sensation or cardiac myocytes.
 29. The method of claim 27, wherein the subject is a mammal.
 30. The method of claim 27, wherein the subject is a human.
 31. A composition for inducible inhibition of a High-Voltage Activated Calcium Channel (HVACC) in a cell comprising: (i) a nanobody according to any one of claims 1-2; and (ii) a C1 domain from protein kinase Cγ(C1_(PKC)) operably connected to the nanobody; wherein the composition is effective to inactivate the HVACC after induction with phorbol-12,13-dibutyrate (PdBu).
 32. The composition of claim 31, wherein the composition is effective to achieve functional knockdown of the HVACC.
 33. A composition comprising a genetically encoded inducible calcium channel blocker comprising a nucleic acid encoding: (i) a nanobody according to any one of claims 1-2; and (ii) a C1 domain from protein kinase Cγ(C1_(PKC)) operably connected to the nanobody.
 34. The composition of claim 33, wherein the nanobody and the C1 domain are expressed to form a contiguous polypeptide.
 35. The composition of claim 33, wherein the nucleic acid encoding (i) and (ii) is carried on an expression vector.
 36. The composition of claim 35, wherein the expression vector further comprises a tissue specific promoter.
 37. A method of blocking a High-Voltage Activated Calcium Channel (HVACC) in a cell, comprising the step of (i) contacting the cell with an effective amount of a composition according to any one of claims 31-36; and (ii) contacting the cell with phorbol-12,13-dibutyrate (PdBu); wherein the contacting of steps (i) and (ii) are effective to remove the HVACC from its functional location on a plasma membrane of the cell.
 38. The method of claim 37, wherein the cell is a neuron or a cardiac myocyte.
 39. A method for treating or ameliorating the effects of a disease in a subject, comprising administering to the subject an effective amount of a composition according to any one of claims 3-24 and 31-36.
 40. The method of claim 39, wherein the subject is a mammal.
 41. The method of claim 39, wherein the subject is a human.
 42. The method of claim 39, wherein the disease is associated with dysregulation of a high-voltage-activated calcium channel (HVACC).
 43. The method of claim 42, wherein the HVACC is selected from the group consisting of Ca_(V)1.1, Ca_(V)1.2, Ca_(V)1.3, Ca_(V)1.4, Ca_(V)2.1, Ca_(V)2.2, Ca_(V)2.3, and combinations thereof.
 44. The method of claim 43, wherein the HVACC is one or more of Ca_(v)1.2, Ca_(v)1.3, Ca_(v)2.1, and Ca_(v)2.3.
 45. The method of claim 39, wherein the disease is selected from the group consisting of a cardiovascular disease, a neurological disease, and combinations thereof.
 46. The method of claim 45, wherein the cardiovascular disease is selected from the group consisting of angina, myocardial infarction, stroke, heart failure, hypertension, cardiac arrhythmias, cerebral vasospasm, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular heart disease, carditis, endocarditis, myocarditis, eosinophilic myocarditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, venous thrombosis, and combinations thereof.
 47. The method of claim 45, wherein the cardiovascular disease is selected from the group consisting of hypertension, cardiac arrhythmias, cerebral vasospasm, and combinations thereof.
 48. The method of claim 45, wherein the neurological disease is selected from the group consisting of epilepsy, chronic pain, Parkinson's disease, amyotrophic lateral sclerosis (ALS), Alzheimer's disease, aneurysm, back pain, Bell's palsy, birth defects of the brain and spinal cord, brain injury, brain tumor, cerebral palsy, chronic fatigue syndrome, consussion, dementia, Disk disease of neck and lower back, dizziness, Guillain-Barré syndrome, headaches and migraines, multiple sclerosis, muscular dystrophy, neuralgia, neuropathy, neuromuscular and related diseases, severe depression, obsessive-compulsive disorder, scoliosis, seizures, spinal cord injury, spinal deformity and disorders, spine tumor, stroke, vertigo, and combinations thereof.
 49. The method of claim 45, wherein the neurological disease is selected from the group consisting of epilepsy, chronic pain, Parkinson's disease, and combinations thereof. 